Provider Demographics
NPI:1306228721
Name:LIFECARE OF MICHIGAN, LLC
Entity Type:Organization
Organization Name:LIFECARE OF MICHIGAN, LLC
Other - Org Name:LIFECARE PHARMACY OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-231-1141
Mailing Address - Street 1:23580 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3241
Mailing Address - Country:US
Mailing Address - Phone:734-261-4400
Mailing Address - Fax:
Practice Address - Street 1:23580 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3241
Practice Address - Country:US
Practice Address - Phone:734-261-4400
Practice Address - Fax:734-261-4803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010106973336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy