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General NPI Number Information
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NPI Number | 1114169034
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Entity Type | Organization
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Legal Business Name | LIFE ABLED LLC
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 125 HALF MILE RD SUITE 200
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City | RED BANK
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State | NJ
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Zip | 07701-6749
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Country | US
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Telephone | 732-444-6333
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Fax | 480-393-5688
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Provider Business Mailing Address
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Address Line | 125 HALF MILE RD SUITE 200
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City | RED BANK
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State | NJ
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Zip | 07701-6749
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Country | US
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Telephone | 732-444-6333
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Fax | 480-393-5688
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Authorized Official
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Title or Position | PRESIDENR/CEO
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Name | MRS. STACEY J WRIGHT
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Credential |
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Telephone | 732-444-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 253E0000X- IN HOME S
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License Number State | NJ
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