Healthcare Provider Details

I. General information

NPI: 1437012200
Provider Name (Legal Business Name): 617 HEALHY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W BIG BEAVER RD STE 1004
TROY MI
48084-4900
US

IV. Provider business mailing address

3905 BEBERNICK LN
STERLING HEIGHTS MI
48310-5370
US

V. Phone/Fax

Practice location:
  • Phone: 248-617-8872
  • Fax:
Mailing address:
  • Phone: 248-617-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA REGAN
Title or Position: OWNER
Credential:
Phone: 248-617-8872