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General NPI Number Information
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NPI Number | 1538831094
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Entity Type | Organization
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Legal Business Name | YOUR BEST LIFE, INC
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Dates
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Enumeration Date | 10/04/2021
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Last Update Date | 10/04/2021
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Provider Practice Location Address
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Address Line | 2360 DAKOTA DR
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City | GRAFTON
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State | WI
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Zip | 53024-9811
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Country | US
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Telephone | 262-483-4061
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Fax |
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Provider Business Mailing Address
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Address Line | 2360 DAKOTA DR
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City | GRAFTON
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State | WI
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Zip | 53024-9811
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Country | US
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Telephone | 262-483-4061
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Fax |
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | SHANA WILD
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Credential |
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Telephone | 262-483-4061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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