Provider Demographics
NPI:1427371293
Name:CREATING INDEPENDENCE LLC
Entity Type:Organization
Organization Name:CREATING INDEPENDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LETTY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-650-1373
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI621610302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization