Healthcare Provider Details

I. General information

NPI: 1114079068
Provider Name (Legal Business Name): LIFE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15419 MIDDLEBELT RD
LIVONIA MI
48154-3805
US

IV. Provider business mailing address

15419 MIDDLEBELT RD
LIVONIA MI
48154-3805
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-1094
  • Fax:
Mailing address:
  • Phone: 734-261-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateMI

VIII. Authorized Official

Name: SUSAN E WELLER
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 734-261-1094