Healthcare Provider Details

I. General information

NPI: 1861088155
Provider Name (Legal Business Name): LIFE BRIDGE HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24001 SOUTHFIELD RD STE 103
SOUTHFIELD MI
48075-2800
US

IV. Provider business mailing address

PO BOX 867
SOUTHFIELD MI
48037-0867
US

V. Phone/Fax

Practice location:
  • Phone: 586-991-1602
  • Fax: 734-212-5084
Mailing address:
  • Phone: 248-971-9005
  • Fax: 734-212-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANIELLE NICOLE MCDANIEL
Title or Position: OWNER
Credential: JD
Phone: 248-971-9005