NPIMap

Organization Active NPI

Mister Life Coach

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Decatur, GA
National Provider Identifier
1619403219
Registry record updated May 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
MISTER LIFE COACH
Practice address
3681 N Decatur Rd Apt R11
Decatur, GA 30032-1062
Phone
(631) 553-7131
NPI assigned
May 3, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2017

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

Authorized official

Name
Mr. Robert Green Jr.
Title
Life Coach
Phone
(631) 553-7131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

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

Mailing address

PO Box 283
Rex, GA 30273-0283

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1493769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493769600000",
    "number": "1619403219",
    "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"
        },
        {
            "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": "2017-05-03",
        "last_updated": "2017-05-03",
        "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",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 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.