Healthcare Provider Details

I. General information

NPI: 1033724786
Provider Name (Legal Business Name): LIFE FORCE FOR OLDER AMERICANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 HAWK COURT
SEVERN MD
21144
US

IV. Provider business mailing address

300 DAVID DRIVE
HAVERTOWN PA
19083
US

V. Phone/Fax

Practice location:
  • Phone: 410-240-4517
  • Fax: 610-359-1117
Mailing address:
  • Phone: 610-203-9200
  • Fax: 910-359-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. VICTOR H EVEREKLIAN
Title or Position: CEO
Credential:
Phone: 610-203-9200