MEDICARE: LIFE RESOURCE CENTER

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
1	251S00000X	Community/Behavioral Health Agency	040341	MI

General Provider Information

NPI Number	:	1649393646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE RESOURCE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 445
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446-0445
Country	:	US
Telephone Number	:	810-245-3885
Fax Number	:	810-667-6459

Provider Business Practice Location Address
First Line	:	3533 FORT KNOX DR
Second Line	:
City	:	LAPEER
State	:	MI
Zip	:	48446-2953
Country	:	US
Telephone Number	:	810-245-3885
Fax Number	:	810-667-6459

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LORRAINE DALE SIMS
Credential	:	MA, LLP, LPC
Telephone Number	:	810-245-3885

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	05/15/2008

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Directions to “LIFE RESOURCE CENTER ” Practice Location

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