Provider Demographics
NPI:1154186724
Name:LIFETOUCH FAMILY CLINIC LLC
Entity type:Organization
Organization Name:LIFETOUCH FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESABELLA
Authorized Official - Middle Name:MAH
Authorized Official - Last Name:TEBID MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-257-2130
Mailing Address - Street 1:9801 GREENBELT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9801 GREENBELT RD STE 103
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6204
Practice Address - Country:US
Practice Address - Phone:240-267-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty