NPIMap

Organization Active NPI

Lifeback of Pennsylvania LLC

  • Adult Mental Health Clinic/Center
  • Doylestown, PA
National Provider Identifier
1457879520
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
LIFEBACK OF PENNSYLVANIA LLC
Practice address
10 S Clinton St Ste 100
Doylestown, PA 18901-4220
Phone
(609) 482-3701
Fax
(215) 975-7300
NPI assigned
Sep 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Authorized official

Name
Marinetta Serotte
Title
President
Phone
(609) 482-3701

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

10 S Clinton St Ste 100
Doylestown, PA 18901-4220

Mailing address

10 S Clinton St Ste 100
Doylestown, PA 18901-4220
Phone (609) 482-3701

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1457879520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 S CLINTON ST STE 100",
            "city": "DOYLESTOWN",
            "state": "PA",
            "postal_code": "189014220",
            "telephone_number": "609-482-3701",
            "fax_number": "215-975-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 S CLINTON ST STE 100",
            "city": "DOYLESTOWN",
            "state": "PA",
            "postal_code": "189014220",
            "telephone_number": "609-482-3701",
            "fax_number": "215-975-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBACK OF PENNSYLVANIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2023-12-28",
        "certification_date": "2023-11-21",
        "status": "A",
        "authorized_official_last_name": "SEROTTE",
        "authorized_official_first_name": "MARINETTA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "609-482-3701"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Doylestown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.