Healthcare Provider Details

I. General information

NPI: 1215407408
Provider Name (Legal Business Name): RESILIENT LIFE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 W HIGHWAY 42
LA GRANGE KY
40031-9554
US

IV. Provider business mailing address

17187 N LAUREL PARK DR STE 160
LIVONIA MI
48152-2692
US

V. Phone/Fax

Practice location:
  • Phone: 512-826-1243
  • Fax:
Mailing address:
  • Phone: 734-482-1200
  • Fax: 734-482-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAD FIFE
Title or Position: CFO
Credential:
Phone: 734-482-1200