Healthcare Provider Details

I. General information

NPI: 1740572494
Provider Name (Legal Business Name): LIFEHEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 LUNENBURG ST SUITE 301
FITCHBURG MA
01420-4566
US

IV. Provider business mailing address

348 LUNENBURG ST SUITE 301
FITCHBURG MA
01420-4566
US

V. Phone/Fax

Practice location:
  • Phone: 978-345-0953
  • Fax:
Mailing address:
  • Phone: 978-345-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ROLAND H UNGERER
Title or Position: OWNER
Credential: MD
Phone: 978-345-0953