Provider Demographics
NPI:1700131661
Name:BETTER LIFE ACTIVITY CENTER INC
Entity Type:Organization
Organization Name:BETTER LIFE ACTIVITY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-412-0407
Mailing Address - Street 1:2400 SOUTH TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:281-412-0407
Mailing Address - Fax:281-412-4684
Practice Address - Street 1:2400 SOUTH TEXAS AVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:281-412-0407
Practice Address - Fax:281-412-4684
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETTER LIFE HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000000Medicaid
TX=========Medicaid