Provider Demographics
NPI:1619553955
Name:LIFTING STAR'S COMMUNITY SERVICES
Entity type:Organization
Organization Name:LIFTING STAR'S COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESHONA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-454-7736
Mailing Address - Street 1:7904 MEAD ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1067
Mailing Address - Country:US
Mailing Address - Phone:313-454-7736
Mailing Address - Fax:
Practice Address - Street 1:7904 MEAD ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1067
Practice Address - Country:US
Practice Address - Phone:313-454-7736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child