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General NPI Number Information
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NPI Number | 1538447065
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Entity Type | Organization
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Legal Business Name | SUCCESSFUL LIVING AFC
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 08/02/2011
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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 | 734-744-4482
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Fax | 734-744-4481
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Provider Business Mailing 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 | 734-744-4482
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Fax | 734-744-4481
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. EARSHA L RIGGIN
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Credential |
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Telephone | 734-744-4481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AS82031326
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License Number State | MI
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