Provider Demographics
NPI:1205066164
Name:FUNCTIONAL LIFE ACHIEVEMENT, INC.
Entity type:Organization
Organization Name:FUNCTIONAL LIFE ACHIEVEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:YIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-683-8905
Mailing Address - Street 1:161 MADISON AVE
Mailing Address - Street 2:SUITE 2W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5421
Mailing Address - Country:US
Mailing Address - Phone:212-683-8905
Mailing Address - Fax:212-683-8906
Practice Address - Street 1:161 MADISON AVE
Practice Address - Street 2:SUITE 2W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5421
Practice Address - Country:US
Practice Address - Phone:212-683-8905
Practice Address - Fax:212-683-8906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0692L001251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management