Provider Demographics
NPI:1477022481
Name:FULL LIFE INDEPENDENCE, LLC
Entity Type:Organization
Organization Name:FULL LIFE INDEPENDENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STOLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-741-1227
Mailing Address - Street 1:3893 S MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9345
Mailing Address - Country:US
Mailing Address - Phone:734-665-7303
Mailing Address - Fax:734-369-2419
Practice Address - Street 1:1019 E SUMMERFIELD GLEN CIR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9163
Practice Address - Country:US
Practice Address - Phone:734-741-1227
Practice Address - Fax:734-369-2419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHTENAW COUNTY CSTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty