NPIMap

Organization Active NPI

Lifelab Kids Foundation

  • Behavior Analyst
  • Ferndale, MI
National Provider Identifier
1992286306
Registry record updated Mar 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
LIFELAB KIDS FOUNDATION
Practice address
3178 Hilton Rd
Ferndale, MI 48220-1059
Phone
(248) 629-4600
Fax
(248) 331-2744
NPI assigned
Aug 23, 2018
Reactivated
Mar 19, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2024

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

Authorized official

Name
Jai Reddy Depa
Title
Owner
Phone
(248) 629-4600

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X Primary
Mental Health Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XM0800X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

3178 Hilton Rd
Ferndale, MI 48220-1059

Mailing address

3178 Hilton Rd
Ferndale, MI 48220-1059
Phone (248) 629-4600

Other identifiers 1

IdentifierTypeStateIssuer
MI17359MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190306002687 MI Part B Supplier - Clinic/Group Practice 0648519769 Practice locations: Ferndale, MI

National Provider Directory

National Provider Directory
Tax ID family
Lifelab Kids Foundation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3178 Hilton Rd
Ferndale, MI 48220
Phone (248) 331-2744

65899 Van Dyke Rd
Washington Twp, MI 48095
Phone (586) 942-2620

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1992286306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3178 HILTON RD",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482201059",
            "telephone_number": "248-629-4600",
            "fax_number": "248-331-2744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3178 HILTON RD",
            "city": "FERNDALE",
            "state": "MI",
            "postal_code": "482201059",
            "telephone_number": "248-629-4600",
            "fax_number": "248-331-2744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFELAB KIDS FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-23",
        "last_updated": "2024-03-20",
        "certification_date": "2024-01-12",
        "deactivation_date": "2024-01-18",
        "reactivation_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "DEPA",
        "authorized_official_first_name": "JAI",
        "authorized_official_middle_name": "REDDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-629-4600"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225XM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MI17359",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ferndale, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.