Healthcare Provider Details

I. General information

NPI: 1114397940
Provider Name (Legal Business Name): LIFE THERAPEUTIC SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 PARKSIDE AVE NW
GRAND RAPIDS MI
49534-3410
US

IV. Provider business mailing address

PO BOX 90002
WYOMING MI
49509-9919
US

V. Phone/Fax

Practice location:
  • Phone: 616-828-5492
  • Fax: 855-207-3270
Mailing address:
  • Phone: 616-828-5492
  • Fax: 855-207-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE SCHWAB
Title or Position: OWNER
Credential: CTRS, ATRIC
Phone: 616-828-5492