Healthcare Provider Details

I. General information

NPI: 1154235869
Provider Name (Legal Business Name): SANTANNA LIVELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17620 W MCNICHOLS RD
DETROIT MI
48235-3327
US

IV. Provider business mailing address

17620 W MCNICHOLS RD
DETROIT MI
48235-3327
US

V. Phone/Fax

Practice location:
  • Phone: 943-302-1476
  • Fax: 404-900-3987
Mailing address:
  • Phone: 943-302-1476
  • Fax: 404-900-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: