NPIMap

Organization Active NPI

Life Skills Village, PLLC

  • Community/Behavioral Health Agency
  • Oak Park, MI
National Provider Identifier
1629316815
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
D31065 Issued in MI
Legal business name
LIFE SKILLS VILLAGE, PLLC
Practice address
25900 Greenfield Rd
Suite 100
Oak Park, MI 48237-1292
Phone
(248) 788-4300
Fax
(248) 605-8099
NPI assigned
Jan 22, 2013
Last updated
Feb 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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

Authorized official

Name
Mr. Nate Gardin
Title
Coo
Phone
(248) 788-4300

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X D31065 MI Primary
Multi-Specialty Clinic/Center 261QM1300X
Rehabilitation Clinic/Center 261QR0400X

Addresses

Primary practice location

25900 Greenfield Rd
Suite 100
Oak Park, MI 48237-1292

Mailing address

20010 Farmington Rd
Livonia, MI 48152-1408
Phone (248) 788-4300

Other practice location 1

4180 Pier North Blvd Ste B
Flint, MI 48504-1361
Phone (248) 788-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140421000357 MI Part B Supplier - Clinic/Group Practice 2860624103 Receives reassigned benefits from 17 practitioners
Practice locations: Oak Park, MI

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

25900 Greenfield Rd
Ste 10
Oak Park, MI 48237
Phone (248) 788-4300

25900 Greenfield Rd
Ste 100
Oak Park, MI 48237
Phone (248) 788-4300

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1629316815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20010 FARMINGTON RD",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481521408",
            "telephone_number": "248-788-4300",
            "fax_number": "248-605-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25900 GREENFIELD RD",
            "address_2": "SUITE 100",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482371292",
            "telephone_number": "248-788-4300",
            "fax_number": "248-605-8099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4180 Pier North Blvd Ste B",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485041361",
            "country_code": "US",
            "telephone_number": "248-788-4300",
            "fax_number": "248-605-8099",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFE SKILLS VILLAGE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-22",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "status": "A",
        "authorized_official_last_name": "GARDIN",
        "authorized_official_first_name": "NATE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "248-788-4300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "D31065",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.