| Life Support Llc | |
|
5270 Northland Dr Ne Grand Rapids MI 49525-1073 | |
| (616) 690-0556 | |
| Not Available |
| Full Name | Life Support Llc |
|---|---|
| Speciality | Social Worker |
| Location | 5270 Northland Dr Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Jason Clauser (OWNER) |
| Authorized Official Contact | 6166900556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Support Llc Po Box 10 Mason MI 48854-0010 Ph: (517) 676-9788 | Life Support Llc 5270 Northland Dr Ne Grand Rapids MI 49525-1073 Ph: (616) 690-0556 |
| NPI Number | 1437518875 |
|---|---|
| Provider Enumeration Date | 02/13/2016 |
| Last Update Date | 02/13/2016 |
| Medicare PECOS PAC ID | 8527347756 |
|---|---|
| Medicare Enrollment ID | O20161110002703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437518875 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lori M Hain |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609945302 PECOS PAC ID: 3779657093 Enrollment ID: I20080805000571 |
| Provider Name | Jason C Clauser |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629397823 PECOS PAC ID: 7618256843 Enrollment ID: I20161110002702 |
| Provider Name | Denise Marie Skonieczny |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528404761 PECOS PAC ID: 5597023317 Enrollment ID: I20171227000556 |
| Provider Name | Thomas J Denczek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568502664 PECOS PAC ID: 4880921642 Enrollment ID: I20190816001210 |
| Provider Name | Keri Ann Fulkerson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770151797 PECOS PAC ID: 6103211974 Enrollment ID: I20220314000475 |
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