Provider Demographics
NPI:1801487632
Name:M.O. L.I.F.E., INC.
Entity type:Organization
Organization Name:M.O. L.I.F.E., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-263-8897
Mailing Address - Street 1:4 LAMBETH PARK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4734
Mailing Address - Country:US
Mailing Address - Phone:508-992-5978
Mailing Address - Fax:
Practice Address - Street 1:4 LAMBETH PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4734
Practice Address - Country:US
Practice Address - Phone:508-992-5978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty