Provider Demographics
NPI:1831789502
Name:ELECTROLIFE INFUSION LLC
Entity type:Organization
Organization Name:ELECTROLIFE INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:ALETHIA
Authorized Official - Last Name:WORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-244-7222
Mailing Address - Street 1:4500 FORBES BLVD STE 200-W21
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6312
Mailing Address - Country:US
Mailing Address - Phone:240-244-7222
Mailing Address - Fax:202-821-1322
Practice Address - Street 1:4500 FORBES BLVD STE 200-W21
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6312
Practice Address - Country:US
Practice Address - Phone:240-244-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRSA-02440OtherRSA