Healthcare Provider Details

I. General information

NPI: 1629538046
Provider Name (Legal Business Name): LIVING LIFE ADULT PROGRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19740 JAMES COUZENS FWY
DETROIT MI
48235-1936
US

IV. Provider business mailing address

19740 JAMES COUZENS FWY
DETROIT MI
48235-1936
US

V. Phone/Fax

Practice location:
  • Phone: 248-818-6556
  • Fax:
Mailing address:
  • Phone: 248-818-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MILANE TAYLOR
Title or Position: OWNER
Credential:
Phone: 248-818-6556