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General NPI Number Information
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NPI Number | 1548128671
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE INTEGRATED RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 43 W AUBURN ST
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City | ECORSE
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State | MI
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Zip | 48229-1803
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Country | US
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Telephone | 313-487-5246
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Fax |
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Provider Business Mailing Address
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Address Line | 43 W AUBURN ST
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City | ECORSE
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State | MI
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Zip | 48229-1803
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Country | US
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Telephone | 313-487-5246
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | RAKIYA MOORE
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Credential | LPN
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Telephone | 313-487-5246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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