Healthcare Provider Details

I. General information

NPI: 1982314399
Provider Name (Legal Business Name): LEVEL AHEAD GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 RIDGEWAY RD
WAVERLY HALL GA
31831-2012
US

IV. Provider business mailing address

4208 18TH AVE
BROOKLYN NY
11218-5720
US

V. Phone/Fax

Practice location:
  • Phone: 706-365-0440
  • Fax: 332-777-1719
Mailing address:
  • Phone: 718-557-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH JALAS
Title or Position: CEO
Credential:
Phone: 718-577-2240