Provider Demographics
NPI:1598290363
Name:MY LIFE MY WAY INC
Entity Type:Organization
Organization Name:MY LIFE MY WAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:304-676-4260
Mailing Address - Street 1:115 AIKENS CTR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-6210
Mailing Address - Country:US
Mailing Address - Phone:304-676-4260
Mailing Address - Fax:304-596-2333
Practice Address - Street 1:115 AIKENS CTR
Practice Address - Street 2:SUITE 10
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6210
Practice Address - Country:US
Practice Address - Phone:304-676-4260
Practice Address - Fax:304-596-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00942627251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV=========Medicaid