Healthcare Provider Details

I. General information

NPI: 1902611643
Provider Name (Legal Business Name): LIFE SAVER WINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

17135 ANNCHESTER RD
DETROIT MI
48219-3525
US

IV. Provider business mailing address

17135 ANNCHESTER RD
DETROIT MI
48219-3525
US

V. Phone/Fax

Practice location:
  • Phone: 248-455-9770
  • Fax:
Mailing address:
  • Phone: 248-455-9770
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAJAUNA HENDRICKS
Title or Position: NURSE
Credential: RN
Phone: 248-455-9770