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
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
MI
347C00000X
Private Vehicle
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
01/16/2014
Last updated
04/19/2017
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