Healthcare Provider Details

I. General information

NPI: 1356250062
Provider Name (Legal Business Name): AMORE LIFE LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22535 LANSE ST
SAINT CLAIR SHORES MI
48081-2609
US

IV. Provider business mailing address

22535 LANSE ST
SAINT CLAIR SHORES MI
48081-2609
US

V. Phone/Fax

Practice location:
  • Phone: 844-266-7354
  • Fax:
Mailing address:
  • Phone: 844-266-7354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LAVEATRICE MARIE BROWN
Title or Position: OWNER/LICENSEE
Credential: RMA, CNA
Phone: 844-266-7354