Provider Demographics
NPI:1528130325
Name:RIVERVIEW LIFELINE CENTER PLLC
Entity type:Organization
Organization Name:RIVERVIEW LIFELINE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CODING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRZUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-388-2032
Mailing Address - Street 1:22201 MOROSS RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2169
Mailing Address - Country:US
Mailing Address - Phone:847-388-2032
Mailing Address - Fax:847-388-2020
Practice Address - Street 1:7633 EAST JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214
Practice Address - Country:US
Practice Address - Phone:847-388-2032
Practice Address - Fax:847-388-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty