Healthcare Provider Details

I. General information

NPI: 1326540394
Provider Name (Legal Business Name): ALL WALKS OF LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

IV. Provider business mailing address

6133 MARLORA RD
BALTIMORE MD
21239-1929
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-0032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: FLOYD E TALIAFERRO
Title or Position: CEO
Credential:
Phone: 410-558-0032