Provider Demographics
NPI:1033487244
Name:CREATING INDEPENDANCE LLC
Entity Type:Organization
Organization Name:CREATING INDEPENDANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-838-4660
Mailing Address - Street 1:416 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1146
Mailing Address - Country:US
Mailing Address - Phone:269-838-4660
Mailing Address - Fax:269-792-2074
Practice Address - Street 1:416 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1146
Practice Address - Country:US
Practice Address - Phone:269-838-4660
Practice Address - Fax:269-792-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care