| Resilient Life Therapeutic Services Llc | |
|
89 E Edsel Ford Fwy Ste 200 Detroit MI 48202-3742 | |
| (248) 943-1814 | |
| Not Available |
| Full Name | Resilient Life Therapeutic Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 89 E Edsel Ford Fwy Ste 200, Detroit, Michigan |
| Authorized Official Name and Position | Jacqueline Maria Beavers (SOLE OWNER) |
| Authorized Official Contact | 2489431814 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Resilient Life Therapeutic Services Llc 19300 Appoline St Detroit MI 48235-1215 Ph: () - | Resilient Life Therapeutic Services Llc 89 E Edsel Ford Fwy Ste 200 Detroit MI 48202-3742 Ph: (248) 943-1814 |
| NPI Number | 1083285407 |
|---|---|
| Provider Enumeration Date | 07/07/2021 |
| Last Update Date | 11/08/2021 |
| Certification Date | 11/08/2021 |
| Medicare PECOS PAC ID | 5890198469 |
|---|---|
| Medicare Enrollment ID | O20210721000318 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083285407 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| Provider Name | Jacqueline Maria Beavers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558718502 PECOS PAC ID: 6709289374 Enrollment ID: I20210721000399 |
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