Healthcare Provider Details

I. General information

NPI: 1215798178
Provider Name (Legal Business Name): LIFE COACH ON THE GO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 NEW YORK AVE APT 1
BROOKLYN NY
11210-2739
US

IV. Provider business mailing address

2918 AVENUE I # 1367
BROOKLYN NY
11210-2935
US

V. Phone/Fax

Practice location:
  • Phone: 844-543-2624
  • Fax:
Mailing address:
  • Phone: 917-946-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEAN J PIERRE-LOUIS
Title or Position: CEO
Credential:
Phone: 929-541-2198