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General NPI Number Information
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NPI Number | 1104200526
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Entity Type | Organization
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Legal Business Name | SUCCESSFULLY LIVING INC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 14341 MERRIMAN RD
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City | LIVONIA
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State | MI
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Zip | 48154-4264
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Country | US
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Telephone | 734-846-1519
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Fax | 734-744-4482
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Provider Business Mailing Address
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Address Line | 14341 MERRIMAN
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City | LIVONIA
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State | MI
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Zip | 48154
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Country | US
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Telephone | 734-846-1519
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Fax | 734-744-4482
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Authorized Official
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Title or Position | OPERATOR
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Name | EARSHA RIGGIN
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Credential |
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Telephone | 734-846-1519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | AS820313236
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License Number State | MI
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