Organization
LIFE PUSH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS CORY STURDIFEN SR. MBA, MA (PRESIDENT)
(919) 891-0205
Entity
Organization
Contact information
Practice address
308 CRAGHEAD ST, DANVILLE, VA 24541-1470
(434) 774-8539
(434) 857-4220
Mailing address
PO BOX 193, WHITSETT, NC 27377-0193
(919) 891-0205
(434) 857-4220
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/19/2020
Last updated
02/19/2020
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