Healthcare Provider Details

I. General information

NPI: 1174605919
Provider Name (Legal Business Name): LIVING SKILLS RESIDENTIAL CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49167 BEMIS RD
BELLEVILLE MI
48111-9761
US

IV. Provider business mailing address

321 DEVONSHIRE ST
DEARBORN MI
48124-1085
US

V. Phone/Fax

Practice location:
  • Phone: 734-461-2204
  • Fax: 734-461-2204
Mailing address:
  • Phone: 313-274-6137
  • Fax: 313-274-6137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY MCMILLAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 313-274-6137