Provider Demographics
NPI:1619358058
Name:LIFE OPPORTUNITIES UNLIMITED
Entity Type:Organization
Organization Name:LIFE OPPORTUNITIES UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:TAMIRIAN
Authorized Official - Last Name:MANDELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-689-1128
Mailing Address - Street 1:75 N MAPLE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3247
Mailing Address - Country:US
Mailing Address - Phone:201-689-1128
Mailing Address - Fax:
Practice Address - Street 1:8-26 PLYMOUTH DR
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1641
Practice Address - Country:US
Practice Address - Phone:201-689-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH1081320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities