Provider Demographics
NPI:1184306953
Name:LIFE EXPERIENCES PA
Entity type:Organization
Organization Name:LIFE EXPERIENCES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANIYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-860-8899
Mailing Address - Street 1:177 PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7965
Mailing Address - Country:US
Mailing Address - Phone:973-860-8899
Mailing Address - Fax:
Practice Address - Street 1:177 PARK RIDGE DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-7965
Practice Address - Country:US
Practice Address - Phone:973-860-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services