Provider Demographics
NPI:1033951819
Name:LIVING N MY SPACE
Entity type:Organization
Organization Name:LIVING N MY SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSW
Authorized Official - Phone:313-926-3524
Mailing Address - Street 1:535 GRISWOLD ST STE 541
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3672
Mailing Address - Country:US
Mailing Address - Phone:313-926-3524
Mailing Address - Fax:
Practice Address - Street 1:19004 OAK DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2264
Practice Address - Country:US
Practice Address - Phone:866-778-3268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management