Healthcare Provider Details

I. General information

NPI: 1578264636
Provider Name (Legal Business Name): LIFEMARK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 S DIVISION ST STE 401
SALISBURY MD
21804-6921
US

IV. Provider business mailing address

1342 S DIVISION ST STE 401
SALISBURY MD
21804-6921
US

V. Phone/Fax

Practice location:
  • Phone: 443-859-8584
  • Fax: 443-859-8496
Mailing address:
  • Phone: 443-859-8584
  • Fax: 443-859-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: HEATHER RADISH
Title or Position: OFFICE MANAGER/BILLING
Credential:
Phone: 443-859-8584