Healthcare Provider Details

I. General information

NPI: 1629888235
Provider Name (Legal Business Name): LIFE POINT HEALTHCARE SERVICES OF DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 306
WASHINGTON DC
20017-2103
US

IV. Provider business mailing address

PO BOX 966
DURHAM NC
27702-0966
US

V. Phone/Fax

Practice location:
  • Phone: 771-217-0303
  • Fax:
Mailing address:
  • Phone: 771-220-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVANTE MULLEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 771-220-9224