INNOVATIVE LIFESTYLES, INC (NPI# 1730615717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730615717 |
| Entity Type | Organization |
| Organization Name | INNOVATIVE LIFESTYLES, INC |
| Practice Address |
5490 Dixie Hwy Suite 1 Waterford MI 48329 |
| Mailing Address |
Po Box 1258 Clarkston MI 48347 |
| Practice Telephone | 2486238898 |
| Practice Fax Number | 2486238899 |
| Mailing Telephone | 2486238898 |
| Mailing Fax Number | 2486238899 |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |
| Authorized Official Name | PAMELA TRAVIS HURLEY (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2486238898 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | AS630279392 | MI | Residential Treatment Facilities |
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | AS630074810 | MI | Residential Treatment Facilities |
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | AS630067389 | MI | Residential Treatment Facilities |
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | AS630279393 | MI | Residential Treatment Facilities |
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | AS630012660 | MI | Residential Treatment Facilities |
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | AS63001546 | MI | Residential Treatment Facilities |
| Street Address |
5490 DIXIE HWY SUITE 1 |
| City | WATERFORD |
| State | MI |
| Zip Code | 48329 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386124139 | Melissa A Blake | Occupational Therapist | 3257 Whitfield Ct, Waterford, MI 48329 | 2018-08-20 |
| 1932699741 | Julianne Marie Fittonneville | Counselor | 4000 W Walton Blvd Ste A&b, Waterford, MI 48329 | 2018-05-16 |
| 1841670502 | Kayla Brianne Dandino | Speech-Language Pathologist | 5601 Hatchery Rd., Waterford Township, MI 48329 | 2015-06-08 |
| 1093122400 | Caring 4 Loved Ones, Inc | Registered Nurse | 3549 Lakeshore Dr., Waterford, MI 48329 | 2014-07-17 |
| 1124448329 | Michael Alan Watson | Emergency Medicine | 5826 Dixie Hwy, Waterford Township, MI 48329 | 2014-04-27 |
| 1417263120 | Metro Imaging Center Plc | Dentist | 4664 W. Walton Blvd., Waterford, MI 48329 | 2010-08-19 |
| 1225278013 | S.e.t. Footcare, P.C. | Podiatrist | 4396-1 Dixie Hwy, Waterford, MI 48329 | 2009-03-06 |
| 1962556498 | Mark Andrew Laszlo | Dentist | 4624 Walton Blvd, Waterford, MI 48329 | 2007-01-22 |
| 1437211927 | Pankajini N Doshi | Pediatrics | 4299 Roseberry Ct, Waterford, MI 48329 | 2006-12-14 |
| 1881767200 | Jeffrey S Ingber | Dentist | 4664 W Walton, Waterford, MI 48329 | 2006-11-15 |
| Find all providers in zip 48329 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538682786 | Verena Louise Love | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2317 Crane St, Waterford, MI 48329-3726 | 2017-07-19 |
| 1336678705 | Sherry Montney | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 232 N Avery Rd, Waterford, MI 48328-2906 | 2017-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144855123 | Hope Shores, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1383 E Maple Ave, Burton, MI 48529-2059 | 2020-03-10 |
| 1760030183 | Specially Made Co. LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 845 E Summerfield Glen Cir, Ann Arbor, MI 48103-9161 | 2019-08-28 |
| 1033776919 | South Coast Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 72633 M 43, South Haven, MI 49090-8734 | 2019-05-25 |
| 1275001448 | St. Jude's Assisted Living | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 509 S 22nd St, Escanaba, MI 49829-2247 | 2018-11-06 |
| 1457826315 | Northrop Loving Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17777 Northrop St, Detroit, MI 48219-2321 | 2018-10-08 |
| 1548745961 | Residential Opportunities Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 612 Landsdowne Ave, Portage, MI 49002-0556 | 2018-10-02 |
| 1134604051 | Unity Group II LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 63 Wood Dr, Coldwater, MI 49036-1046 | 2018-09-26 |
| 1578048401 | Unity Group V LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 69 Wood Dr, Coldwater, MI 49036-1046 | 2018-09-26 |
| 1417432337 | Unity Group IIi LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1831 Case Dr, Union City, MI 49094-9348 | 2018-09-26 |
| 1033694963 | Unity Group Iv LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 126 Gail Ann Dr, Coldwater, MI 49036-9327 | 2018-09-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.