Healthcare Provider Details

I. General information

NPI: 1952998601
Provider Name (Legal Business Name): LIFE WITHOUT LIMITS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 N BROAD ST
HILLSIDE NJ
07205-2403
US

IV. Provider business mailing address

1284 N BROAD ST
HILLSIDE NJ
07205-2403
US

V. Phone/Fax

Practice location:
  • Phone: 973-454-0771
  • Fax:
Mailing address:
  • Phone: 973-454-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TARA JONES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-454-0771