Healthcare Provider Details

I. General information

NPI: 1649393646
Provider Name (Legal Business Name): LIFE RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 FORT KNOX DR
LAPEER MI
48446-2953
US

IV. Provider business mailing address

PO BOX 445
LAPEER MI
48446-0445
US

V. Phone/Fax

Practice location:
  • Phone: 810-245-3885
  • Fax: 810-667-6459
Mailing address:
  • Phone: 810-245-3885
  • Fax: 810-667-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number040341
License Number StateMI

VIII. Authorized Official

Name: MRS. LORRAINE DALE SIMS
Title or Position: OWNER
Credential: MA, LLP, LPC
Phone: 810-245-3885