Provider Demographics
NPI:1780552026
Name:APPALACHIAN CENTER FOR INDEPENDENT LIVING, INC.
Entity type:Organization
Organization Name:APPALACHIAN CENTER FOR INDEPENDENT LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-965-0376
Mailing Address - Street 1:4710 CHIMNEY DR STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4841
Mailing Address - Country:US
Mailing Address - Phone:304-965-0376
Mailing Address - Fax:304-965-0377
Practice Address - Street 1:4710 CHIMNEY DR STE C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-4841
Practice Address - Country:US
Practice Address - Phone:304-965-0376
Practice Address - Fax:304-965-0377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities