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General NPI Number Information
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NPI Number | 1417092180
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Entity Type | Organization
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Legal Business Name | LIVONIA LIFE CENTER CORP
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34441 8 MILE RD SUITE 104
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City | LIVONIA
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State | MI
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Zip | 48152-4013
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Country | US
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Telephone | 248-442-0662
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Fax | 248-442-0663
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Provider Business Mailing Address
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Address Line | 34441 8 MILE RD SUITE 104
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City | LIVONIA
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State | MI
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Zip | 48152-4013
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Country | US
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Telephone | 248-442-0662
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Fax | 248-442-0663
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Authorized Official
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Title or Position | OWNER
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Name | ANGEL MERINO
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Credential |
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Telephone | 734-686-2036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | MI
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