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General NPI Number Information
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NPI Number | 1528400348
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Entity Type | Organization
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Legal Business Name | LIFE RENEWAL SERVICES, INC
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 247 E MAIN ST
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City | WESTMINSTER
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State | MD
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Zip | 21157-5228
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Country | US
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Telephone | 410-277-8910
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 865
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City | WESTMINSTER
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State | MD
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Zip | 21158-0865
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | QA
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Name | LISA FONTAINE
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Credential |
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Telephone | 410-277-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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