Provider Demographics
NPI:1154823417
Name:HIGHLIFE HOMECARE INC
Entity Type:Organization
Organization Name:HIGHLIFE HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-INCORPORATOR / CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-890-8883
Mailing Address - Street 1:38910 MINTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3322
Mailing Address - Country:US
Mailing Address - Phone:248-890-8883
Mailing Address - Fax:888-345-0261
Practice Address - Street 1:38910 MINTON AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3322
Practice Address - Country:US
Practice Address - Phone:248-890-8883
Practice Address - Fax:888-345-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care