Provider Demographics
NPI:1154569317
Name:LIFE HEALTH CENTER
Entity type:Organization
Organization Name:LIFE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:H
Authorized Official - Last Name:UNGERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-345-0953
Mailing Address - Street 1:348 LUNENBURG MA
Mailing Address - Street 2:#301
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420
Mailing Address - Country:US
Mailing Address - Phone:978-345-0953
Mailing Address - Fax:978-345-0585
Practice Address - Street 1:348 LUNENBURG ST # MA
Practice Address - Street 2:#301
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4566
Practice Address - Country:US
Practice Address - Phone:978-345-0953
Practice Address - Fax:978-345-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33670103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty