Experience Living, LLC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

Legal business name

EXPERIENCE LIVING, LLC

Doing business as

Skippers Road Ventures, LLC

Practice address

1829 Westridge Dr
Rochester Hills, MI 48306-3276

Phone

(248) 760-7665

NPI assigned

Nov 27, 2017

Last updated

Nov 27, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stefan Stration

Title

President

Phone

(248) 760-7665

Specialties & licenses 1

Addresses

Other names 1

• Skippers Road Ventures, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511740800000",
    "number": "1437663689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1829 WESTRIDGE DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483063276",
            "telephone_number": "248-760-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1829 WESTRIDGE DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483063276",
            "telephone_number": "248-760-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERIENCE LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-27",
        "last_updated": "2017-11-27",
        "status": "A",
        "authorized_official_last_name": "STRATION",
        "authorized_official_first_name": "STEFAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-760-7665"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skippers Road Ventures, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kody Fagin, DC
• Taylor Fair, LPC

• Early Intervention Provider Agency in Rochester Hills, MI
• Providers in Rochester Hills, MI by specialty
• Early Intervention Provider Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.