Provider Demographics
NPI:1679388342
Name:CIRCUMSTANCES OF LIFE MICHIGAN, INC
Entity type:Organization
Organization Name:CIRCUMSTANCES OF LIFE MICHIGAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KISHAWNDRIA
Authorized Official - Middle Name:SHANTAA
Authorized Official - Last Name:JONES-MINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-552-4609
Mailing Address - Street 1:PO BOX 5212
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-0212
Mailing Address - Country:US
Mailing Address - Phone:734-552-4609
Mailing Address - Fax:
Practice Address - Street 1:14797 ROSEMARY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1539
Practice Address - Country:US
Practice Address - Phone:734-552-4609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-10
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty