NPIMap

Organization Active NPI

Life Push, LLC

  • Community/Behavioral Health Agency
  • Danville, VA
National Provider Identifier
1497388458
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LIFE PUSH, LLC
Practice address
308 Craghead St
Danville, VA 24541-1470
Phone
(434) 774-8539
Fax
(434) 857-4220
NPI assigned
Feb 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Mr. Nicholas Cory Sturdifen Sr., MBA, MA
Title
President
Phone
(919) 891-0205

Specialties & licenses 1

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

Addresses

Primary practice location

308 Craghead St
Danville, VA 24541-1470

Mailing address

PO Box 193
Whitsett, NC 27377-0193
Phone (919) 891-0205

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1497388458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 193",
            "city": "WHITSETT",
            "state": "NC",
            "postal_code": "273770193",
            "telephone_number": "919-891-0205",
            "fax_number": "434-857-4220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 CRAGHEAD ST",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245411470",
            "telephone_number": "434-774-8539",
            "fax_number": "434-857-4220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE PUSH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "STURDIFEN",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "CORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-891-0205",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MBA, MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.