Provider Demographics
NPI:1629888235
Name:LIFE POINT HEALTHCARE SERVICES OF DC LLC
Entity type:Organization
Organization Name:LIFE POINT HEALTHCARE SERVICES OF DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:771-220-9224
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-0966
Mailing Address - Country:US
Mailing Address - Phone:771-220-9224
Mailing Address - Fax:
Practice Address - Street 1:1160 VARNUM ST NE STE 306
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2103
Practice Address - Country:US
Practice Address - Phone:771-217-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children