Provider Demographics
NPI:1093198673
Name:LIFELINK THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:LIFELINK THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISELDA
Authorized Official - Middle Name:CUETO
Authorized Official - Last Name:DE LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:248-703-1711
Mailing Address - Street 1:31201 CHICAGO RD S
Mailing Address - Street 2:STE. B-301
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5527
Mailing Address - Country:US
Mailing Address - Phone:586-558-9112
Mailing Address - Fax:586-558-9113
Practice Address - Street 1:31201 CHICAGO RD S
Practice Address - Street 2:STE. B-301
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5527
Practice Address - Country:US
Practice Address - Phone:586-558-9112
Practice Address - Fax:586-558-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470417987163W00000X
MI5501006363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty