Mister Life Coach

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

MISTER LIFE COACH

Practice address

3681 N Decatur Rd Apt R11
Decatur, GA 30032-1062

Phone

(631) 553-7131

NPI assigned

Apr 25, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Green

Title

Life Coach

Phone

(631) 553-7131

Specialties & licenses 1

Addresses

Tax ID family

Mister Life Coach2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mister Life Coach

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Decatur, GA
  • NPI 1619403219
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493078400000",
    "number": "1508391756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 283",
            "city": "REX",
            "state": "GA",
            "postal_code": "302730283",
            "telephone_number": "631-553-7131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3681 N DECATUR RD APT R11",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321062",
            "telephone_number": "631-553-7131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISTER LIFE COACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-25",
        "last_updated": "2017-04-25",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "LIFE COACH",
        "authorized_official_telephone_number": "631-553-7131"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Decatur, GA
• Providers in Decatur, GA by specialty
• Mental Illness Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.