Provider Demographics
NPI:1043926942
Name:GREAT LIFE STEPS, LLC
Entity Type:Organization
Organization Name:GREAT LIFE STEPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CDS, BA
Authorized Official - Phone:973-280-0208
Mailing Address - Street 1:1307 GREENWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-3042
Mailing Address - Country:US
Mailing Address - Phone:973-280-0208
Mailing Address - Fax:
Practice Address - Street 1:1307 GREENWAY BLVD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-3042
Practice Address - Country:US
Practice Address - Phone:973-280-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty