Provider Demographics
NPI:1902247158
Name:ACHE TO LIVE INC.
Entity Type:Organization
Organization Name:ACHE TO LIVE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADC/MH
Authorized Official - Phone:405-596-0178
Mailing Address - Street 1:625 E ELDER LN
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4617
Mailing Address - Country:US
Mailing Address - Phone:405-506-0178
Mailing Address - Fax:405-491-0407
Practice Address - Street 1:4211 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-3007
Practice Address - Country:US
Practice Address - Phone:405-789-7805
Practice Address - Fax:405-491-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK797101YA0400X
OK4803101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty