Provider Demographics
NPI:1841674777
Name:LIFESTREAM HEALTH CENTER
Entity type:Organization
Organization Name:LIFESTREAM HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-860-0305
Mailing Address - Street 1:4000 MITCHELLVILLE RD
Mailing Address - Street 2:B322
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3104
Mailing Address - Country:US
Mailing Address - Phone:301-860-0305
Mailing Address - Fax:301-860-0307
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:B322
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-860-0305
Practice Address - Fax:301-860-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2020-06-11
Deactivation Date:2020-06-04
Deactivation Code:
Reactivation Date:2020-06-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD275532Medicare UPIN