MEDICARE: FREEDOMS LIFESTYLE 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
1	385H00000X	Respite Care		MI

General Provider Information

NPI Number	:	1649678236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOMS LIFESTYLE LLC

Provider Business Mailing Address
First Line	:	33312 GRAND RIVER AVE
Second Line	:	SUITE 201
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-3124
Country	:	US
Telephone Number	:	248-426-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	33312 GRAND RIVER AVE
Second Line	:	SUITE 201
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48336-3124
Country	:	US
Telephone Number	:	248-426-8989
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE COORDINATOR
Name	:	SHERI GREEN
Credential	:
Telephone Number	:	248-426-8989

Provider Enumeration Date	:	12/12/2014
Last Update Date	:	12/12/2014

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