Provider Demographics
NPI:1427567833
Name:GUIDED LIFE STRUCTURES
Entity Type:Organization
Organization Name:GUIDED LIFE STRUCTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-704-0011
Mailing Address - Street 1:75 VETERANS MEMORIAL DR E STE 205
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2949
Mailing Address - Country:US
Mailing Address - Phone:908-704-0011
Mailing Address - Fax:908-704-0711
Practice Address - Street 1:75 VETERANS MEMORIAL DR E STE 205
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2949
Practice Address - Country:US
Practice Address - Phone:908-704-0011
Practice Address - Fax:908-704-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000133261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0116378OtherNPI