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NPI Code Detail

MEDICARE: LIFEBULB LLC

MEDICARE: LIFEBULB 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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1699491464
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEBULB LLC
Provider Business Mailing Address
First Line : 505 MAIN ST
Second Line :
City : TOMS RIVER
State : NJ
Zip : 08753-7443
Country : US
Telephone Number : 434-944-7565
Fax Number :
Provider Business Practice Location Address
First Line : 505 MAIN ST
Second Line :
City : TOMS RIVER
State : NJ
Zip : 08753-7443
Country : US
Telephone Number : 434-944-7565
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DANIEL BELCHER
Credential :
Telephone Number : 434-944-7565
Provider Enumeration Date : 10/13/2022
Last Update Date : 10/13/2022

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Directions to “LIFEBULB LLC ” Practice Location

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