Organization
LIFE GO'S ON TRANSITIONAL ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUANNA CHERISE HARDAWAY (OWNER)
(313) 310-6258
Entity
Organization
Contact information
Practice address
2600 FENKELL ST, DETROIT, MI 48238-2819
(313) 310-6258
Mailing address
4269 FULLERTON ST, DETROIT, MI 48238-3234
(313) 310-6256
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
11/16/2013
Last updated
11/16/2013
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