| Lead4life, Inc. | |
|
176 Thomas Johnson Dr Ste 203 Frederick MD 21702-4535 | |
| (301) 672-4319 | |
| Not Available |
| Full Name | Lead4life, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 176 Thomas Johnson Dr Ste 203, Frederick, Maryland |
| Authorized Official Name and Position | Jennifer M Gauthier (CEO EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3016724319 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lead4life, Inc. 2096 Gaither Rd Ste 110 Rockville MD 20850-4027 Ph: (301) 672-4319 | Lead4life, Inc. 176 Thomas Johnson Dr Ste 203 Frederick MD 21702-4535 Ph: (301) 672-4319 |
| NPI Number | 1326695073 |
|---|---|
| Provider Enumeration Date | 08/19/2019 |
| Last Update Date | 08/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326695073 | NPI | - | NPPES |
| 201507200 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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