Provider Demographics
NPI:1588151047
Name:LIFE OPPORTUNITIES UNLIMITED: A NON PROFIT CORPORATION
Entity type:Organization
Organization Name:LIFE OPPORTUNITIES UNLIMITED: A NON PROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMIRIAN-MANDELI
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:201-689-1128
Mailing Address - Street 1:75 NORTH MAPLE AVE SUITE 104
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-689-1128
Mailing Address - Fax:201-689-1136
Practice Address - Street 1:2 BEAM PLACE
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508
Practice Address - Country:US
Practice Address - Phone:201-689-1128
Practice Address - Fax:201-689-1136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE OPPORTUNITIES UNLIMITED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities