Provider Demographics
NPI:1760876825
Name:LIFE TRANSITION SERVICES LLC
Entity Type:Organization
Organization Name:LIFE TRANSITION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-414-0707
Mailing Address - Street 1:21031 SUNNYDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3143
Mailing Address - Country:US
Mailing Address - Phone:586-663-8906
Mailing Address - Fax:
Practice Address - Street 1:21031 SUNNYDALE ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3143
Practice Address - Country:US
Practice Address - Phone:586-663-8906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704199416251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0872184OtherBLUE CROSS