Provider Demographics
NPI:1346577947
Name:LIFE STAR OF MICHIGAN LLC
Entity Type:Organization
Organization Name:LIFE STAR OF MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-416-5000
Mailing Address - Street 1:40400 ANN ARBOR RD E STE 104A
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6611
Mailing Address - Country:US
Mailing Address - Phone:734-416-5000
Mailing Address - Fax:
Practice Address - Street 1:40400 ANN ARBOR RD E STE 104A
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6611
Practice Address - Country:US
Practice Address - Phone:734-416-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010847421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty