Provider Demographics
NPI:1891380044
Name:LIFE YOGA LLC
Entity Type:Organization
Organization Name:LIFE YOGA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGENDANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-488-4938
Mailing Address - Street 1:20726 HALL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1537
Mailing Address - Country:US
Mailing Address - Phone:586-488-4938
Mailing Address - Fax:
Practice Address - Street 1:20217 HALL RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-4205
Practice Address - Country:US
Practice Address - Phone:586-488-4938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty