Provider Demographics
NPI:1598195240
Name:LIFE GO'S ON TRANSITIONAL ORGANIZATION
Entity Type:Organization
Organization Name:LIFE GO'S ON TRANSITIONAL ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUANNA
Authorized Official - Middle Name:CHERISE
Authorized Official - Last Name:HARDAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-310-6258
Mailing Address - Street 1:4269 FULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3234
Mailing Address - Country:US
Mailing Address - Phone:313-310-6256
Mailing Address - Fax:
Practice Address - Street 1:2600 FENKELL ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-2819
Practice Address - Country:US
Practice Address - Phone:313-310-6258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-16
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)