Provider Demographics
NPI:1457033888
Name:DARIUS PETTWAY LIFE SKOOL CORPORATION
Entity Type:Organization
Organization Name:DARIUS PETTWAY LIFE SKOOL CORPORATION
Other - Org Name:LIFE SKOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:PETTWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:214-945-0642
Mailing Address - Street 1:PO BOX 210061
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-0061
Mailing Address - Country:US
Mailing Address - Phone:214-945-0642
Mailing Address - Fax:
Practice Address - Street 1:4849 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-6503
Practice Address - Country:US
Practice Address - Phone:214-945-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health