Organization
LIFE SKILLS VILLAGE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATE GARDIN (COO)
(248) 788-4300
Entity
Organization
Contact information
Practice address
25900 GREENFIELD RD, SUITE 100, OAK PARK, MI 48237-1292
(248) 788-4300
(248) 605-8099
Mailing address
20010 FARMINGTON RD, LIVONIA, MI 48152-1408
(248) 788-4300
(248) 605-8099
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
D31065
MI
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
01/22/2013
Last updated
02/12/2020
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