Provider Demographics
NPI:1548533896
Name:LIFE CENTER MIHP
Entity type:Organization
Organization Name:LIFE CENTER MIHP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:313-704-4837
Mailing Address - Street 1:20245 PICADILLY RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1308
Mailing Address - Country:US
Mailing Address - Phone:313-704-4837
Mailing Address - Fax:
Practice Address - Street 1:20245 PICADILLY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1308
Practice Address - Country:US
Practice Address - Phone:313-704-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care