Provider Demographics
NPI:1548633076
Name:IT'S MY LIFE, INC.
Entity type:Organization
Organization Name:IT'S MY LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIBAT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:484-350-1029
Mailing Address - Street 1:5925 TILGHMAN ST, SUITE 90
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3063
Mailing Address - Country:US
Mailing Address - Phone:484-350-1029
Mailing Address - Fax:
Practice Address - Street 1:5925 TILGHMAN ST STE 90
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9140
Practice Address - Country:US
Practice Address - Phone:484-350-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services