1194906677 NPI number — INDEPENDENT LIVING CENTERS, INC.

Table of content: (NPI 1194906677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194906677 NPI number — INDEPENDENT LIVING CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT LIVING CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194906677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 N RAINBOW BLVD STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89107-1193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-643-4443
Provider Business Mailing Address Fax Number:
702-878-8761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 GOLD CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89403-8405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-297-3387
Provider Business Practice Location Address Fax Number:
702-878-8761
Provider Enumeration Date:
11/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRAHAM
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-643-4443

Provider Taxonomy Codes

  • Taxonomy code: 3104A0630X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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