# LIFESPAN HOME WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306297668
- **Authorized official:** AISHA ABDUL-SAMAD (MS, CCC-SLP)
- **Authorized official phone:** (443) 306-9406

## Contact information

- **Practice address:** 5615 ASHBURN TER, FREDERICK, MD 21703-9491
- **Practice address phone:** (555) 555-5555
- **Mailing address:** 5615 ASHBURN TER, FREDERICK, MD 21703-9491
- **Mailing address phone:** (443) 306-9406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 05356 | MD | Yes |

## Other

- **Enumeration date:** 06/28/2016
- **Last updated:** 06/28/2016