Provider Demographics
NPI:1992095277
Name:LIFE BEYOND
Entity type:Organization
Organization Name:LIFE BEYOND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-705-7636
Mailing Address - Street 1:435 BURDETT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3785
Mailing Address - Country:US
Mailing Address - Phone:678-705-7636
Mailing Address - Fax:
Practice Address - Street 1:435 BURDETT RIDGE CT
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3785
Practice Address - Country:US
Practice Address - Phone:678-705-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty