Full Life Haven

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

FULL LIFE HAVEN

Practice address

11731 Glen Mill Rd
Potomac, MD 20854-1916

Phone

(301) 379-5088

NPI assigned

Aug 9, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Henry Mere, MPA

Title

Principal

Phone

(301) 379-5088

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1831827880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11731 GLEN MILL RD",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208541916",
            "telephone_number": "301-379-5088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11731 GLEN MILL RD",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208541916",
            "telephone_number": "301-379-5088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL LIFE HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-09",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-08",
        "status": "A",
        "authorized_official_last_name": "MERE",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "301-379-5088",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "medical@dynquest.com",
            "affiliation": "N",
            "endpointDescription": "medical@dynquest.com",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11731 Glen Mill Rd",
            "city": "Potomac",
            "state": "MD",
            "country_code": "US",
            "postal_code": "208541916",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diane Lynch Fraser, DOCTORAL
• Stephen Fredd, MD
• Marilyn Brenda Freidkin, OPTICIAN
• Barrie Konigsberg Friedman, LCSW-C
• Penelope Friedman, MD
• Isatu Fatu Funna
• Lesley-Anne Furlong, M.D.
• Gale Saler & Associates LLC
• Samuel Robert Galitzer, D.P.M.
• Lynne Golubow Gans, M.S., CCC-SLP

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Potomac, MD
• Providers in Potomac, MD by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.