Provider Demographics
NPI:1366302820
Name:LIFELONG SUPPORT INC
Entity type:Organization
Organization Name:LIFELONG SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NWANNE
Authorized Official - Middle Name:UMAZI
Authorized Official - Last Name:UDEAGHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-615-9100
Mailing Address - Street 1:14709 SUSAN MARIE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8617
Mailing Address - Country:US
Mailing Address - Phone:202-615-9100
Mailing Address - Fax:
Practice Address - Street 1:14709 SUSAN MARIE WAY
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8617
Practice Address - Country:US
Practice Address - Phone:202-615-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities