Provider Demographics
NPI:1649652678
Name:CARE FOR LIFE COMMUNITY SERVICES
Entity type:Organization
Organization Name:CARE FOR LIFE COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATUM
Authorized Official - Middle Name:LATRELL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:734-272-2245
Mailing Address - Street 1:1595 STEPHENS DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3244
Mailing Address - Country:US
Mailing Address - Phone:734-272-2245
Mailing Address - Fax:
Practice Address - Street 1:1595 STEPHENS DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3244
Practice Address - Country:US
Practice Address - Phone:734-272-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703089162251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health