Provider Demographics
NPI:1225598634
Name:LIFE OPPORTUNITIES UNLIMITED A NON-PROFIT CORP.
Entity Type:Organization
Organization Name:LIFE OPPORTUNITIES UNLIMITED A NON-PROFIT CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TAMIRIAN-MANDELI
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:201-689-1128
Mailing Address - Street 1:75 NORTH MAPLE AVE SUITE 104
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-689-1128
Mailing Address - Fax:201-689-1136
Practice Address - Street 1:43 BERKSHIRE PL
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-2005
Practice Address - Country:US
Practice Address - Phone:201-689-1128
Practice Address - Fax:201-689-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0531545Medicaid