| Leota Lifestar Llc | |
|
75 Thomas Johnson Dr Suite E Frederick MD 21702-4895 | |
| (240) 405-9059 | |
| (443) 283-4038 |
| Full Name | Leota Lifestar Llc |
|---|---|
| Speciality | Counselor |
| Location | 75 Thomas Johnson Dr, Frederick, Maryland |
| Authorized Official Name and Position | Sandra E Marley (VICE PRESIDENT) |
| Authorized Official Contact | 2404056865 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Leota Lifestar Llc 75 Thomas Johnson Dr Suite E Frederick MD 21702-4895 Ph: (240) 405-9059 | Leota Lifestar Llc 75 Thomas Johnson Dr Suite E Frederick MD 21702-4895 Ph: (240) 405-9059 |
| NPI Number | 1598085011 |
|---|---|
| Provider Enumeration Date | 06/07/2010 |
| Last Update Date | 06/07/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598085011 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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