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NPI Code Detail

MEDICARE: RESILIENT LIFE CENTER, LLC

MEDICARE: RESILIENT LIFE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1407679020
Entity Type Code : Organization
Provider Name (Legal Business Name) : RESILIENT LIFE CENTER, LLC
Provider Business Mailing Address
First Line : PO BOX 4504
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23112-0010
Country : US
Telephone Number : 804-317-5710
Fax Number : 804-763-3453
Provider Business Practice Location Address
First Line : 9513 HULL STREET RD STE A
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23236-1495
Country : US
Telephone Number : 804-317-5710
Fax Number : 804-763-3453
Authorized Official
Title or Position : CEO
Name : JENNIFER ANN KELL
Credential : LSW
Telephone Number : 804-317-5710
Provider Enumeration Date : 11/04/2024
Last Update Date : 11/04/2024

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