Organization
LIVE LONG AND HEALTHYLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DEBRA APRIL LATOCK MIKEM RN, BSN (ADMINISTRATOR)
(410) 215-4145
Entity
Organization
Contact information
Practice address
1117 E NORTHERN PKWY, BALTIMORE, MD 21239-1930
(410) 215-4145
Mailing address
1117 E NORTHERN PKWY, BALTIMORE, MD 21239-1930
(410) 215-4145
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
01/28/2015
Last updated
01/28/2015
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