MEDICARE: MADE LIFE FOREVER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1174474951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADE LIFE FOREVER LLC

Provider Business Mailing Address
First Line	:	12196 SANTA ROSA DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-5317
Country	:	US
Telephone Number	:	313-374-8943
Fax Number	:	313-447-3457

Provider Business Practice Location Address
First Line	:	12196 SANTA ROSA DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-5317
Country	:	US
Telephone Number	:	313-374-8943
Fax Number	:	313-447-3457

Authorized Official
Title or Position	:	CEO
Name	:	MARIE A MARSHALL
Credential	:
Telephone Number	:	313-697-2985

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “MADE LIFE FOREVER LLC ” Practice Location

Language	Start Address	Practice Location

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