Provider Demographics
NPI:1134618713
Name:LIFECARE & RECOVERY
Entity type:Organization
Organization Name:LIFECARE & RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:586-549-1816
Mailing Address - Street 1:5265 PEEKSKILL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3440
Mailing Address - Country:US
Mailing Address - Phone:586-549-1816
Mailing Address - Fax:
Practice Address - Street 1:2946 ROUNDTREE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2347
Practice Address - Country:US
Practice Address - Phone:586-549-1816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI802191909251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1235332941Medicaid
MI802191909Medicaid
MI373940219Medicaid