Healthcare Provider Details

I. General information

NPI: 1154249902
Provider Name (Legal Business Name): LIVELY RESIDENTIAL PARADISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16558 MANSFIELD ST
DETROIT MI
48235-3631
US

IV. Provider business mailing address

16558 MANSFIELD ST
DETROIT MI
48235-3631
US

V. Phone/Fax

Practice location:
  • Phone: 313-229-6215
  • Fax: 404-900-3987
Mailing address:
  • Phone: 313-229-6215
  • Fax: 404-900-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SANTANNA LIVELY
Title or Position: OWNER
Credential:
Phone: 313-340-2225