Provider Demographics
NPI:1508281288
Name:LIFE SERVICES SYSTEM OF OTTAWA COUNTY
Entity Type:Organization
Organization Name:LIFE SERVICES SYSTEM OF OTTAWA COUNTY
Other - Org Name:LIFE SERVICES PARENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-396-7566
Mailing Address - Street 1:11172 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9163
Mailing Address - Country:US
Mailing Address - Phone:616-396-7566
Mailing Address - Fax:616-396-6893
Practice Address - Street 1:11172 ADAMS ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-9163
Practice Address - Country:US
Practice Address - Phone:616-396-7566
Practice Address - Fax:616-396-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096280252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency