Provider Demographics
NPI:1144689050
Name:LIFEBRIDGE REHABILITATION SERVICES, LLC
Entity type:Organization
Organization Name:LIFEBRIDGE REHABILITATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:KRAJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-601-5136
Mailing Address - Street 1:3855 GREENSPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-3300
Mailing Address - Country:US
Mailing Address - Phone:410-225-9337
Mailing Address - Fax:
Practice Address - Street 1:2211 W ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4420
Practice Address - Country:US
Practice Address - Phone:443-810-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEBRIDGE COMMUNITY PHYSICIANS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21-6706Medicare PIN