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General NPI Number Information
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NPI Number | 1417197252
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Entity Type | Organization
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Legal Business Name | ANN ARBOR CENTER FOR INDEPENDENT LIVING
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 3941 RESEARCH PARK DRIVE
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City | ANN ARBOR
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State | MI
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Zip | 48108-2215
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Country | US
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Telephone | 734-971-0277
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Fax | 734-971-0826
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Provider Business Mailing Address
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Address Line | 3941 RESEARCH PARK DRIVE
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City | ANN ARBOR
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State | MI
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Zip | 48108-2215
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Country | US
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Telephone | 734-971-0277
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Fax | 734-971-0826
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, INTERIM
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Name | MR. LEWIS ALEXANDER GOSSAGE
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Credential |
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Telephone | 734-971-0277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801062814
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801067044
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801089981
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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