1205352986 NPI number — A LIFE YOU LOVE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205352986 NPI number — A LIFE YOU LOVE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A LIFE YOU LOVE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205352986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 NORTH AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07016-2126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-456-1871
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 DUMONT RD
Provider Second Line Business Practice Location Address:
PO BOX 953
Provider Business Practice Location Address City Name:
FAR HILLS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07931-0793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-456-1871
Provider Business Practice Location Address Fax Number:
908-456-1871
Provider Enumeration Date:
08/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KIEBLER-BROGAN
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/OWNER
Authorized Official Telephone Number:
908-456-1871

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  37PC00083500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 37PC00083500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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