Organization
INNOVATIVE LIFESTYLES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA TRAVIS HURLEY (EXECUTIVE DIRECTOR)
(248) 623-8898
Entity
Organization
Contact information
Practice address
5490 DIXIE HWY, SUITE 1, WATERFORD, MI 48329
(248) 623-8898
(248) 623-8899
Mailing address
PO BOX 1258, CLARKSTON, MI 48347
(248) 623-8898
(248) 623-8899
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS630012660
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
AS630015466
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS630067389
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS630074810
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS630279392
MI
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
AS630279393
MI
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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