Healthcare Provider Details

I. General information

NPI: 1679388342
Provider Name (Legal Business Name): CIRCUMSTANCES OF LIFE MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14797 ROSEMARY ST
DETROIT MI
48213-1539
US

IV. Provider business mailing address

PO BOX 5212
DETROIT MI
48205-0212
US

V. Phone/Fax

Practice location:
  • Phone: 734-552-4609
  • Fax:
Mailing address:
  • Phone: 734-552-4609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. KISHAWNDRIA SHANTAA JONES-MINER
Title or Position: PROVIDER
Credential:
Phone: 734-552-4609