Healthcare Provider Details

I. General information

NPI: 1336202811
Provider Name (Legal Business Name): INDEPENDENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 PAWTUCKET AVE UNIT 3
EAST PROVIDENCE RI
02914-1716
US

IV. Provider business mailing address

2224 PAWTUCKET AVE UNIT 3
EAST PROVIDENCE RI
02914-1716
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-8888
  • Fax: 401-273-9986
Mailing address:
  • Phone: 401-273-8888
  • Fax: 401-273-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TODD ACKERMAN
Title or Position: PRESIDENT
Credential:
Phone: 401-273-8888