Provider Demographics
| NPI: | 1598318560 |
|---|---|
| Name: | CYCLE OF LIFE LLC |
| Entity type: | Organization |
| Organization Name: | CYCLE OF LIFE LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | COORDINATOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | THERESA |
| Authorized Official - Middle Name: | LATRICE |
| Authorized Official - Last Name: | WILLIAMS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 616-608-3341 |
| Mailing Address - Street 1: | 740 32ND ST SE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WYOMING |
| Mailing Address - State: | MI |
| Mailing Address - Zip Code: | 49548-2329 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 616-608-3341 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 740 32ND ST SE |
| Practice Address - Street 2: | |
| Practice Address - City: | WYOMING |
| Practice Address - State: | MI |
| Practice Address - Zip Code: | 49548-2329 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 616-608-3341 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-07-18 |
| Last Update Date: | 2019-12-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251E00000X | Agencies | Home Health | ||
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 2278H0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Home Health | Group - Multi-Specialty |
| No | 253Z00000X | Agencies | In Home Supportive Care | ||
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 251B00000X | Agencies | Case Management |
