Provider Demographics
NPI:1881410041
Name:GOOD LIFE ADVANCEMENT AND DEVELOPMENT INC
Entity type:Organization
Organization Name:GOOD LIFE ADVANCEMENT AND DEVELOPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHRAKH
Authorized Official - Suffix:
Authorized Official - Credentials:MSED/SPED
Authorized Official - Phone:646-541-3424
Mailing Address - Street 1:65 MARINE WAY FL 2
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5733
Mailing Address - Country:US
Mailing Address - Phone:646-541-3424
Mailing Address - Fax:
Practice Address - Street 1:65 MARINE WAY FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5733
Practice Address - Country:US
Practice Address - Phone:646-541-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency