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NPI Code Detail

MEDICARE: LEAD4LIFE, INC.

MEDICARE: LEAD4LIFE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326695073
Entity Type Code : Organization
Provider Name (Legal Business Name) : LEAD4LIFE, INC.
Provider Business Mailing Address
First Line : 2096 GAITHER RD STE 110
Second Line :
City : ROCKVILLE
State : MD
Zip : 20850-4027
Country : US
Telephone Number : 301-672-4319
Fax Number :
Provider Business Practice Location Address
First Line : 176 THOMAS JOHNSON DR STE 203
Second Line :
City : FREDERICK
State : MD
Zip : 21702-4535
Country : US
Telephone Number : 301-672-4319
Fax Number :
Authorized Official
Title or Position : CEO EXECUTIVE DIRECTOR
Name : JENNIFER M GAUTHIER
Credential :
Telephone Number : 301-672-4319
Provider Enumeration Date : 08/19/2019
Last Update Date : 08/19/2019

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Directions to “LEAD4LIFE, INC. ” Practice Location

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