Provider Demographics
NPI:1609507177
Name:ACHIEVE QUALITY OF LIFE
Entity Type:Organization
Organization Name:ACHIEVE QUALITY OF LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:MARISA
Authorized Official - Last Name:KRAKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-373-1145
Mailing Address - Street 1:11831 HARVARD LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4663
Mailing Address - Country:US
Mailing Address - Phone:317-373-1145
Mailing Address - Fax:
Practice Address - Street 1:13295 ILLINOIS ST STE 124
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3020
Practice Address - Country:US
Practice Address - Phone:317-373-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty