=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972390524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEULIFE REHABILITATION OF MICHIGAN, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2025
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1409 ALLEN DR STE G
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48083-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-300-6338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 189 ADAM SHEPHERD PARKWAY, SUITE 17 PMB #280
-----------------------------------------------------
City | SHEP
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-300-6338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PATRICK G KELLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 586-300-5866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------