NPIMap

Organization Active NPI

Northeast Independent Living Services

  • Homemaker
  • Hannibal, MO
National Provider Identifier
1457528085
Registry record updated Mar 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
HomemakerTaxonomy code 376J00000X
Legal business name
NORTHEAST INDEPENDENT LIVING SERVICES
Practice address
4500 Paris Gravel Rd
Hannibal, MO 63401-5422
Phone
(573) 221-8282
Fax
(573) 221-9445
NPI assigned
May 13, 2008
Last updated
Mar 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2023

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

Authorized official

Name
Tara Fortner
Title
Finance Director
Phone
(573) 221-8282

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X
Chore Provider 372500000X
Homemaker 376J00000X Primary
Respite Care 385H00000X
In Home Supportive Care Agency 253Z00000X
Supports Brokerage Agency 251X00000X

Addresses

Primary practice location

4500 Paris Gravel Rd
Hannibal, MO 63401-5422

Mailing address

4500 Paris Gravel Rd
Hannibal, MO 63401-5422
Phone (573) 221-8282

Other identifiers 2

IdentifierTypeStateIssuer
286213707MedicaidMO
266213701MedicaidMO

National Provider Directory

National Provider Directory
Tax ID family
Northeast Independent Living Services5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4500 Paris Gravel Rd
Hannibal, MO 63401
Phone (573) 221-8282

909 Broadway
Ste 350
Hannibal, MO 63401
Phone (573) 221-8282

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1457528085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 PARIS GRAVEL RD",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634015422",
            "telephone_number": "573-221-8282",
            "fax_number": "573-221-9445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 PARIS GRAVEL RD",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634015422",
            "telephone_number": "573-221-8282",
            "fax_number": "573-221-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDEPENDENT LIVING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "FORTNER",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "573-221-8282"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "372500000X",
            "taxonomy_group": "",
            "desc": "Chore Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "286213707",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266213701",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; 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.