Provider Demographics
NPI:1841513744
Name:INSTITUTE FOR LIFE ENRICHMENT
Entity type:Organization
Organization Name:INSTITUTE FOR LIFE ENRICHMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-291-2008
Mailing Address - Street 1:7852 16TH STREET NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-0000
Mailing Address - Country:US
Mailing Address - Phone:202-291-5008
Mailing Address - Fax:202-291-2080
Practice Address - Street 1:6201 GREENBELT ROAD
Practice Address - Street 2:M7
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-0000
Practice Address - Country:US
Practice Address - Phone:301-474-3750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD773211201Medicaid