Healthcare Provider Details

I. General information

NPI: 1528260700
Provider Name (Legal Business Name): REAL LIFE LIVING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 FULLER AVE NE STE 213
GRAND RAPIDS MI
49505-3459
US

IV. Provider business mailing address

PO BOX 3915
ANN ARBOR MI
48106-3915
US

V. Phone/Fax

Practice location:
  • Phone: 231-887-4080
  • Fax: 231-887-4422
Mailing address:
  • Phone: 734-476-9834
  • Fax: 231-887-4422

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 Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WOODSIDE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 734-476-9834