=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154529394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED LIFESTYLES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 S NELSON ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48838-2138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-406-4551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 S NELSON ST
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48838-2138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-406-4551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. JODIE FABER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-406-4551
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------