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General NPI Number Information
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NPI Number | 1114789526
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Entity Type | Organization
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Legal Business Name | KEY OF LIFE, LLC
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 3002 CARPENTER ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-2768
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Country | US
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Telephone | 586-265-8230
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 CARPENTER ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-2768
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Country | US
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Telephone | 313-288-9793
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Fax | 313-447-2709
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Authorized Official
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Title or Position | OWNER
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Name | GINA IBRAHIM
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Credential | BCBA
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Telephone | 586-265-8230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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