Independent Lifestyle Clubhouse LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

INDEPENDENT LIFESTYLE CLUBHOUSE LLC

Practice address

4427 Inkster Rd
Inkster, MI 48141-3058

Phone

(313) 622-3287

NPI assigned

Aug 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Shondra Lynn Jackson

Title

Director

Phone

(313) 622-3287

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1235685694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29723 STEINHAUER ST",
            "city": "INKSTER",
            "state": "MI",
            "postal_code": "481413419",
            "telephone_number": "313-622-3287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4427 INKSTER RD",
            "city": "INKSTER",
            "state": "MI",
            "postal_code": "481413058",
            "telephone_number": "313-622-3287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT LIFESTYLE CLUBHOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "SHONDRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-622-3287",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cierra Hughes
• Darnell Hurt
• Aaron Thomas Hynes, M.A., LLPC
• Darcel Leann Ingram Moore
• Inkster Community Resource & Referral Center, LLC
• Inner Healing Consulting LLC
• Noraymil Isidro
• Ali Hassan Ismail, PHARMD

• Adult Mental Health Clinic/Center in Inkster, MI
• Providers in Inkster, MI by specialty
• Adult Mental Health Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.