Provider Demographics
NPI:1568262335
Name:LIFE PEARLS SUPPORT SERVICES
Entity type:Organization
Organization Name:LIFE PEARLS SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-462-0296
Mailing Address - Street 1:6201 DARROWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9126
Mailing Address - Country:US
Mailing Address - Phone:240-462-0296
Mailing Address - Fax:
Practice Address - Street 1:6201 DARROWBERRY CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9126
Practice Address - Country:US
Practice Address - Phone:240-462-0296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services