NPIMap

Organization Active NPI

Lead4Life, Inc.

  • Community/Behavioral Health Agency
  • Frederick, MD
National Provider Identifier
1326695073
Registry record updated Aug 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LEAD4LIFE, INC.
Practice address
176 Thomas Johnson Dr Ste 203
Frederick, MD 21702-4535
Phone
(301) 672-4319
NPI assigned
Aug 19, 2019
Last updated
Aug 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2019

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

Authorized official

Name
Jennifer M GauthierNPI 1912142753
Title
Ceo Executive Director
Phone
(301) 672-4319

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

176 Thomas Johnson Dr Ste 203
Frederick, MD 21702-4535

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
201507200MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Frederick

National Provider Directory

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

Other organizations with this tax ID 6

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

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": "1566172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566172800000",
    "number": "1326695073",
    "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": "176 THOMAS JOHNSON DR STE 203",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024535",
            "telephone_number": "301-672-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAD4LIFE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-19",
        "last_updated": "2019-08-19",
        "status": "A",
        "authorized_official_last_name": "GAUTHIER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-672-4319"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201507200",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Frederick",
            "affiliation": "N",
            "address_1": "176 Thomas Johnson Dr Ste 203",
            "city": "Frederick",
            "state": "MD",
            "country_code": "US",
            "postal_code": "217024535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2019; 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.