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General NPI Number Information
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NPI Number | 1831511393
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Entity Type | Organization
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Legal Business Name | LIFESTYLES SUPPORTIVE LIVING SERVICES, LLC
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 2370 E STADIUM BLVD # 640
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City | ANN ARBOR
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State | MI
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Zip | 48104-4811
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Country | US
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Telephone | 734-726-4086
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Fax |
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Provider Business Mailing Address
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Address Line | 2370 E STADIUM BLVD # 640
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City | ANN ARBOR
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State | MI
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Zip | 48104-4811
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Country | US
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Telephone | 734-726-4086
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MANUEL DEWITT THOMAS JR.
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Credential |
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Telephone | 734-726-4086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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