Northeast Independent Living Services
Organization Active NPI Homemaker · Hannibal, MO
NPI 1457528085 · NPPES record last updated Mar 8, 2023
Key facts
- NPI
- 1457528085
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Homemaker 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
- Organization subpart
- No
Authorized official
- Name
- Tara Fortner
- Title
- Finance Director
- Phone
- (573) 221-8282
Corporate family (same tax ID) 4
National Provider Directory
- Tax ID family
- Northeast Independent Living Services
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Care Agency | 251J00000X | |||
| Supports Brokerage Agency | 251X00000X | |||
| In Home Supportive Care Agency | 253Z00000X | |||
| Chore Provider |
372500000X | |||
| Homemaker |
376J00000X | Yes | ||
| Respite Care | 385H00000X |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 266213701 | Medicaid | MO | |
| 286213707 | Medicaid | MO |
Other providers in Hannibal, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.