Provider Demographics
NPI:1952693152
Name:MY LIFE INC.
Entity Type:Organization
Organization Name:MY LIFE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SLUZALIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-419-4136
Mailing Address - Street 1:197 WILLOW TRACE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-9264
Mailing Address - Country:US
Mailing Address - Phone:570-419-4136
Mailing Address - Fax:
Practice Address - Street 1:197 WILLOW TRACE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-9264
Practice Address - Country:US
Practice Address - Phone:570-419-4136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA660113650OtherMCI