North Central Independent Living Services,Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

NORTH CENTRAL INDEPENDENT LIVING SERVICES,INC

Practice address

1120 25TH Ave
Black Eagle, MT 59414-1037

Phone

(406) 452-9834

Fax

(406) 453-3940

NPI assigned

Oct 6, 2015

Last updated

Jan 17, 2024By 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

Tom OsbornNPI 1043680994

Title

Executive Director

Phone

(406) 452-9834

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tom Osborn

  • Contractor
  • Black Eagle, MT
  • NPI 1043680994
  NPD Authorized official

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1518337286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 25TH AVE",
            "city": "BLACK EAGLE",
            "state": "MT",
            "postal_code": "594141037",
            "telephone_number": "406-452-9834",
            "fax_number": "406-453-3940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 25TH AVE",
            "city": "BLACK EAGLE",
            "state": "MT",
            "postal_code": "594141037",
            "telephone_number": "406-452-9834",
            "fax_number": "406-453-3940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CENTRAL INDEPENDENT LIVING SERVICES,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-06",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "OSBORN",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "406-452-9834"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "MT",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136084",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "193766",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Fry
• Tom Osborn

• In Home Supportive Care Agency in Black Eagle, MT
• Providers in Black Eagle, MT by specialty
• In Home Supportive Care Agency in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.