Healthcare Provider Details

I. General information

NPI: 1235368549
Provider Name (Legal Business Name): A LIFE AT HOME LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 ORCHARD LAKE RD
ORCHARD LAKE MI
48323-1641
US

IV. Provider business mailing address

4115 ORCHARD LAKE RD
ORCHARD LAKE MI
48323-1641
US

V. Phone/Fax

Practice location:
  • Phone: 248-504-4974
  • Fax: 248-419-5105
Mailing address:
  • Phone: 248-504-4974
  • Fax: 248-419-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberNA - NON MEDICAL
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberB526149847888
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberNA - NON MEDICAL
License Number StateMI

VIII. Authorized Official

Name: MR. DOUGLAS VICTOR BEAMGARD
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 248-504-4974