Organization
LIFEWAY-GAMBURD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN BURFIELD (GENERAL COUNCIL)
(814) 594-0185
Entity
Organization
Contact information
Practice address
12405 MONTAGUE ST, PACOIMA, CA 91331-2122
(310) 861-7476
Mailing address
1125 MIDDLE ST STE 202D, MIDDLETOWN, CT 06457-1587
Taxonomy
Speciality
Code
Description
License number
State
225XE0001X
Environmental Modification Occupational Therapist
Primary
—
—
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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