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General NPI Number Information
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NPI Number | 1861088155
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Entity Type | Organization
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Legal Business Name | LIFE BRIDGE HEALTH SERVICES LLC
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 03/21/2026
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Provider Practice Location Address
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Address Line | 24001 SOUTHFIELD RD STE 103
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2800
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Country | US
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Telephone | 586-991-1602
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Fax | 734-212-5084
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Provider Business Mailing Address
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Address Line | PO BOX 867
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City | SOUTHFIELD
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State | MI
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Zip | 48037-0867
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Country | US
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Telephone | 248-971-9005
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Fax | 734-212-5084
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DANIELLE NICOLE MCDANIEL
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Credential | JD
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Telephone | 248-971-9005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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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 | 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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Taxonomy #3
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care 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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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