Healthcare Provider Details

I. General information

NPI: 1316351992
Provider Name (Legal Business Name): LIFELINE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41800 HAYES RD SUITE 208
CLINTON TOWNSHIP MI
48038-1876
US

IV. Provider business mailing address

PO BOX 216
WASHINGTON MI
48094-0216
US

V. Phone/Fax

Practice location:
  • Phone: 888-910-9922
  • Fax:
Mailing address:
  • Phone: 888-910-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801096616
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6801096616
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number6801096616
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801096616
License Number StateMI

VIII. Authorized Official

Name: MRS. SHERITA HARVEY
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW
Phone: 586-343-2154