Provider Demographics
NPI:1215407408
Name:RESILIENT LIFE CARE, LLC
Entity Type:Organization
Organization Name:RESILIENT LIFE CARE, LLC
Other - Org Name:RESILIENT LIFE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-482-1200
Mailing Address - Street 1:17187 N LAUREL PARK DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2692
Mailing Address - Country:US
Mailing Address - Phone:734-482-1200
Mailing Address - Fax:734-482-3202
Practice Address - Street 1:1512 W HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9554
Practice Address - Country:US
Practice Address - Phone:512-826-1243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness