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General NPI Number Information
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NPI Number | 1629888235
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Entity Type | Organization
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Legal Business Name | LIFE POINT HEALTHCARE SERVICES OF DC LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 1160 VARNUM ST NE STE 306
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City | WASHINGTON
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State | DC
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Zip | 20017-2103
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Country | US
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Telephone | 771-217-0303
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | DURHAM
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State | NC
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Zip | 27702-0966
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Country | US
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Telephone | 771-220-9224
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DEVANTE MULLEN
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Credential |
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Telephone | 771-220-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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