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General NPI Number Information
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NPI Number | 1245610807
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Entity Type | Organization
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Legal Business Name | EPIC LIFE INC.
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 2305 MINNESOTA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-5325
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Country | US
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Telephone | 240-641-2674
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Fax | 240-280-8460
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Provider Business Mailing Address
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Address Line | 1523 WHITE PL SE LOWER LEVEL
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City | WASHINGTON
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State | DC
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Zip | 20020-5343
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Country | US
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Telephone | 240-641-2674
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Fax | 240-280-8460
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Authorized Official
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Title or Position | CEO
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Name | YDIA GORDON
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Credential |
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Telephone | 240-641-2674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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