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NPI Code Detail

MEDICARE: LIFE SUPPORT LLC

MEDICARE: LIFE SUPPORT LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1437518875
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE SUPPORT LLC
Provider Business Mailing Address
First Line : PO BOX 10
Second Line :
City : MASON
State : MI
Zip : 48854-0010
Country : US
Telephone Number : 517-676-9788
Fax Number : 517-676-3438
Provider Business Practice Location Address
First Line : 5270 NORTHLAND DR NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49525-1073
Country : US
Telephone Number : 616-690-0556
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JASON CLAUSER
Credential : LMSW
Telephone Number : 616-690-0556
Provider Enumeration Date : 02/13/2016
Last Update Date : 02/13/2016

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Directions to “LIFE SUPPORT LLC ” Practice Location

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