Organization
CREATING INDEPENDENCE III LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB DAMRON CARE PROVIDER (MEMBER OWNER)
(269) 509-7266
Entity
Organization
Contact information
Practice address
416 E SUPERIOR ST, WAYLAND, MI 49348-1146
(269) 509-7266
Mailing address
416 E SUPERIOR ST, WAYLAND, MI 49348-1146
(269) 509-7266
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
07/11/2016
Last updated
07/13/2016
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