Provider Demographics
NPI:1417197252
Name:ANN ARBOR CENTER FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:ANN ARBOR CENTER FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, INTERIM
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:GOSSAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-971-0277
Mailing Address - Street 1:3941 RESEARCH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2215
Mailing Address - Country:US
Mailing Address - Phone:734-971-0277
Mailing Address - Fax:734-971-0826
Practice Address - Street 1:3941 RESEARCH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2215
Practice Address - Country:US
Practice Address - Phone:734-971-0277
Practice Address - Fax:734-971-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010628141041C0700X
MI68010670441041C0700X
MI68010899811041C0700X
251B00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management