Provider Demographics
NPI:1821307620
Name:LIFE & DESTINY BUILDERS
Entity Type:Organization
Organization Name:LIFE & DESTINY BUILDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:/OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-721-1526
Mailing Address - Street 1:29460 STELLAMAR DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5272
Mailing Address - Country:US
Mailing Address - Phone:248-721-1526
Mailing Address - Fax:
Practice Address - Street 1:19400 JOY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3035
Practice Address - Country:US
Practice Address - Phone:248-721-1526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health