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General NPI Number Information
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NPI Number | 1467089482
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Entity Type | Organization
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Legal Business Name | IFLP LIVES LLC
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 3311 BATEMAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21216-1807
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Country | US
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Telephone | 410-669-8083
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Fax |
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Provider Business Mailing Address
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Address Line | 3311 BATEMAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21216-1807
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Country | US
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Telephone | 410-669-8083
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THERESA HARRIS
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Credential |
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Telephone | 410-908-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0813X
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Taxonomy Name | Geropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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