Provider Demographics
NPI:1992526313
Name:4LIFE HEALTHCARE LLC
Entity type:Organization
Organization Name:4LIFE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARIJEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA-BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-826-5678
Mailing Address - Street 1:41994 CEDAR POINT PL
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2693
Mailing Address - Country:US
Mailing Address - Phone:703-826-5678
Mailing Address - Fax:833-283-0249
Practice Address - Street 1:44355 PREMIER PLZ STE 120
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5050
Practice Address - Country:US
Practice Address - Phone:703-826-5678
Practice Address - Fax:833-283-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy