NPIMap

Organization Active NPI

Lead 4 Life, Inc.

  • Community/Behavioral Health Agency
  • Salisbury, MD
National Provider Identifier
1215689294
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LEAD 4 LIFE, INC.
Practice address
100 Clemwood St
Salisbury, MD 21804-6489
Phone
(443) 978-7864
Fax
(443) 859-8880
NPI assigned
Jan 21, 2022
Organization subpart
Yes
Parent organization
LEAD4LIFE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tamara Denise Reynolds
Title
Office Manager
Phone
(443) 978-7864

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

100 Clemwood St
Salisbury, MD 21804-6489

Mailing address

2096 Gaither Rd Ste 110
Rockville, MD 20850-4027
Phone (301) 672-4319

Other identifiers 1

IdentifierTypeStateIssuer
201507201MedicaidMD

Other names 1

  • Lead4Life, Inc Former legal business name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address PRPMD@lead4lifeinc.org Direct

National Provider Directory

National Provider Directory
Tax ID family
Lead4Life Inc7 organizations share this tax ID, including this one
Part of
Lead4Life Inc

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 Clemwood St
Salisbury, MD 21804
Phone (443) 978-7864

Interoperability endpoints

  • Direct secure messaging: prpmd@lead4lifeinc.org

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642723200000",
    "number": "1215689294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2096 GAITHER RD STE 110",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504027",
            "telephone_number": "301-672-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CLEMWOOD ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046489",
            "telephone_number": "443-978-7864",
            "fax_number": "443-859-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAD 4 LIFE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEAD4LIFE, INC.",
        "enumeration_date": "2022-01-21",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "443-978-7864"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201507201",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PRPMD@lead4lifeinc.org",
            "affiliation": "N",
            "endpointDescription": "PRPMD@lead4lifeinc.org",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Clemwood St",
            "city": "Salisbury",
            "state": "MD",
            "country_code": "US",
            "postal_code": "218046489",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lead4Life, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.