| Life Star Of Michigan Llc | |
|
40400 Ann Arbor Rd E Ste 104a Plymouth MI 48170-6611 | |
| (734) 416-5000 | |
| Not Available |
| Full Name | Life Star Of Michigan Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 40400 Ann Arbor Rd E Ste 104a, Plymouth, Michigan |
| Authorized Official Name and Position | Kathie Schofield (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7344165000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Star Of Michigan Llc 40400 Ann Arbor Rd E Ste 104a Plymouth MI 48170-6611 Ph: (734) 416-5000 | Life Star Of Michigan Llc 40400 Ann Arbor Rd E Ste 104a Plymouth MI 48170-6611 Ph: (734) 416-5000 |
| NPI Number | 1346577947 |
|---|---|
| Provider Enumeration Date | 11/03/2009 |
| Last Update Date | 11/03/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346577947 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6801084742 (Michigan) | Primary |
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