Provider Demographics
NPI:1104572775
Name:ONE ALKALINE LIFE, LLC
Entity type:Organization
Organization Name:ONE ALKALINE LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-934-0581
Mailing Address - Street 1:5800 BETSY CIR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3301
Mailing Address - Country:US
Mailing Address - Phone:410-934-0580
Mailing Address - Fax:410-834-1217
Practice Address - Street 1:1036 SAINT NICHOLAS DR UNIT 102
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4758
Practice Address - Country:US
Practice Address - Phone:410-934-0580
Practice Address - Fax:410-834-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD317218000Medicaid