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General NPI Number Information
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NPI Number | 1033988407
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Entity Type | Organization
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Legal Business Name | SULLIVAN LIFESTYLE SOLUTIONS LLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 24123 GREENFIELD RD STE 306
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3124
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Country | US
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Telephone | 248-275-3870
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Fax | 248-918-4337
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Provider Business Mailing Address
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Address Line | 28401 MOUND RD UNIT 1664
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City | WARREN
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State | MI
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Zip | 48090-7259
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Country | US
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Telephone | 248-275-3870
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Fax | 248-918-4337
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Authorized Official
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Title or Position | MANAGING MANAGER
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Name | TALIA SIMONE AZIR
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Credential | MSW
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Telephone | 248-275-3870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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