Provider Demographics
NPI:1326123258
Name:UNITED LIFESTYLES
Entity Type:Organization
Organization Name:UNITED LIFESTYLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-406-4551
Mailing Address - Street 1:407 S NELSON ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-2138
Mailing Address - Country:US
Mailing Address - Phone:800-406-4551
Mailing Address - Fax:
Practice Address - Street 1:407 S NELSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2138
Practice Address - Country:US
Practice Address - Phone:800-406-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251J00000X251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4352647Medicaid