| Organization Name: | LIFE- ALYSIS KIDNEY CENTER, LLC |
| NPI Number: | 1255442190 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LYLE MARUICE GRAY (PARTNER) |
| Mailing Address: | 5830 Conner St Detroit |
| State: | MI US |
| Postal Code: | 482133458 |
| Phone Number: | 3133715433 |
| Fax Number: | 3133716937 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 01/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | 302R00000X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |