Provider Demographics
NPI:1649993643
Name:LIVE RITE STRUCTURED RECOVERY CORP
Entity type:Organization
Organization Name:LIVE RITE STRUCTURED RECOVERY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-217-5899
Mailing Address - Street 1:27700 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4879
Mailing Address - Country:US
Mailing Address - Phone:586-217-5899
Mailing Address - Fax:
Practice Address - Street 1:27700 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4879
Practice Address - Country:US
Practice Address - Phone:586-217-5899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty