Healthcare Provider Details

I. General information

NPI: 1669383220
Provider Name (Legal Business Name): LIFE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3964 RAVENSFIELD DR
CANTON MI
48188-7925
US

IV. Provider business mailing address

46036 MICHIGAN AVE # 141
CANTON MI
48188-2304
US

V. Phone/Fax

Practice location:
  • Phone: 734-351-2926
  • Fax: 734-340-2854
Mailing address:
  • Phone: 734-351-2926
  • Fax: 734-340-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELE ELAINE FAULKCON
Title or Position: OWNER
Credential:
Phone: 734-351-2926