Provider Demographics
NPI:1215615646
Name:LIFEWAY-GAMBURD LLC
Entity type:Organization
Organization Name:LIFEWAY-GAMBURD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNCIL
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-594-0185
Mailing Address - Street 1:1125 MIDDLE ST STE 202D
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12405 MONTAGUE ST
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-2122
Practice Address - Country:US
Practice Address - Phone:310-861-7476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Multi-Specialty