MEDICARE: LIFE ABLED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	253E0000X- IN HOME S	NJ

General Provider Information

NPI Number	:	1114169034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ABLED LLC

Provider Business Mailing Address
First Line	:	125 HALF MILE RD
Second Line	:	SUITE 200
City	:	RED BANK
State	:	NJ
Zip	:	07701-6749
Country	:	US
Telephone Number	:	732-444-6333
Fax Number	:	480-393-5688

Provider Business Practice Location Address
First Line	:	125 HALF MILE RD
Second Line	:	SUITE 200
City	:	RED BANK
State	:	NJ
Zip	:	07701-6749
Country	:	US
Telephone Number	:	732-444-6333
Fax Number	:	480-393-5688

Authorized Official
Title or Position	:	PRESIDENR/CEO
Name	:	MRS. STACEY J WRIGHT
Credential	:
Telephone Number	:	732-444-6333

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	05/14/2009

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