Healthcare Provider Details

I. General information

NPI: 1770397366
Provider Name (Legal Business Name): LIVES SAVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 SOUTHERN AVE
CAPITOL HEIGHTS MD
20743-5767
US

IV. Provider business mailing address

4235 SOUTHERN AVE
CAPITOL HEIGHTS MD
20743-5767
US

V. Phone/Fax

Practice location:
  • Phone: 240-618-3104
  • Fax:
Mailing address:
  • Phone: 240-618-3104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OLUWAKEMI OLUBUNMI OSIDELE
Title or Position: PRESIDENT
Credential:
Phone: 240-575-9940