MEDICARE: FIGHTIN4LIVES, 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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1457887531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIGHTIN4LIVES, LLC

Provider Business Mailing Address
First Line	:	812 H ST NE
Second Line	:	SUITE B
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3629
Country	:	US
Telephone Number	:	202-869-3743
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 H ST NE
Second Line	:	SUITE B
City	:	WASHINGTON
State	:	DC
Zip	:	20002-3629
Country	:	US
Telephone Number	:	202-869-3743
Fax Number	:

Authorized Official
Title or Position	:	CEO/MEDICAL DIRECTOR
Name	:	LATEIA HILL
Credential	:	PA-C
Telephone Number	:	202-869-3743

Provider Enumeration Date	:	05/10/2017
Last Update Date	:	05/10/2017

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