Provider Demographics
NPI:1104200526
Name:SUCCESSFULLY LIVING INC
Entity Type:Organization
Organization Name:SUCCESSFULLY LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:EARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-846-1519
Mailing Address - Street 1:14341 MERRIMAN
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-846-1519
Mailing Address - Fax:734-744-4482
Practice Address - Street 1:14341 MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-4264
Practice Address - Country:US
Practice Address - Phone:734-846-1519
Practice Address - Fax:734-744-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820313236320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities