Provider Demographics
NPI:1417642638
Name:KULEA LYFE LLC
Entity Type:Organization
Organization Name:KULEA LYFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:
Authorized Official - First Name:TERRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:732-822-0786
Mailing Address - Street 1:907 WEXFORD CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-3581
Mailing Address - Country:US
Mailing Address - Phone:723-822-0786
Mailing Address - Fax:
Practice Address - Street 1:907 WEXFORD CT
Practice Address - Street 2:
Practice Address - City:EDGEWATER PARK
Practice Address - State:NJ
Practice Address - Zip Code:08010-3581
Practice Address - Country:US
Practice Address - Phone:723-822-0786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child