Provider Demographics
NPI:1649393646
Name:LIFE RESOURCE CENTER
Entity Type:Organization
Organization Name:LIFE RESOURCE CENTER
Other - Org Name:LIFE RESOURCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLP, LPC
Authorized Official - Phone:810-245-3885
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-0445
Mailing Address - Country:US
Mailing Address - Phone:810-245-3885
Mailing Address - Fax:810-667-6459
Practice Address - Street 1:3533 FORT KNOX DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2953
Practice Address - Country:US
Practice Address - Phone:810-245-3885
Practice Address - Fax:810-667-6459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI040341251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health