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Organization
LIFESTYLES SUPPORTIVE LIVING SERVICES, LLC
Active
Organization
LIFESTYLES SUPPORTIVE LIVING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MANUEL DEWITT THOMAS JR. (ADMINISTRATOR)
(734) 726-4086
Entity
Organization
Contact information
Practice address
2370 E STADIUM BLVD # 640, ANN ARBOR, MI 48104-4811
(734) 726-4086
Mailing address
2370 E STADIUM BLVD # 640, ANN ARBOR, MI 48104-4811
(734) 726-4086
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
320800000X
Mental Illness Community Based Residential Treatment Facility
—
MI
347C00000X
Private Vehicle
—
NULL
3747A0650X
Attendant Care Provider
—
NULL
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
01/16/2014
Last updated
04/19/2017
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