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General NPI Number Information
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NPI Number | 1356763767
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Entity Type | Organization
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Legal Business Name | LIFE BRIDGE HEALTH
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 1909 OLIVINE CT
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City | SILVER SPRING
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State | MD
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Zip | 20904-5323
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Country | US
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Telephone | 240-476-1069
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Fax |
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Provider Business Mailing Address
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Address Line | 1909 OLIVINE CT
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City | SILVER SPRING
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State | MD
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Zip | 20904-5323
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Country | US
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Telephone | 240-476-1069
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Fax |
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Authorized Official
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Title or Position | PA-C
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Name | DANIEL TSIGE TAMERAT
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Credential |
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Telephone | 240-476-1069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | C0005298
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License Number State | MD
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