Provider Demographics
NPI:1902000540
Name:GUIDED LIFE STRUCTURES LLC
Entity Type:Organization
Organization Name:GUIDED LIFE STRUCTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OERTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-704-0011
Mailing Address - Street 1:75 VETERANS MEMORIAL DR E.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
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
Practice Address - Street 2:SUITE 205
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-704-0011
Practice Address - Fax:908-704-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000133-06101YA0400X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0116319OtherWORKFIRST
NJ0116378Medicaid