Healthcare Provider Details

I. General information

NPI: 1831789502
Provider Name (Legal Business Name): ELECTROLIFE INFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORBES BLVD STE 200-W21
LANHAM MD
20706-6312
US

IV. Provider business mailing address

4500 FORBES BLVD STE 200-W21
LANHAM MD
20706-6312
US

V. Phone/Fax

Practice location:
  • Phone: 240-244-7222
  • Fax:
Mailing address:
  • Phone: 240-244-7222
  • Fax: 202-821-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TATYANA ALETHIA WORTHY
Title or Position: DIRECTOR
Credential: RN
Phone: 240-244-7222