Provider Demographics
NPI:1629538046
Name:LIVING LIFE ADULT PROGRAM LLC
Entity Type:Organization
Organization Name:LIVING LIFE ADULT PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-818-6556
Mailing Address - Street 1:19740 JAMES COUZENS FWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1936
Mailing Address - Country:US
Mailing Address - Phone:248-818-6556
Mailing Address - Fax:
Practice Address - Street 1:19740 JAMES COUZENS FWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1936
Practice Address - Country:US
Practice Address - Phone:248-818-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-21
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care