Independence Living Solutions Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

INDEPENDENCE LIVING SOLUTIONS INC

Practice address

2822 Spoonbill TRL
Orange Park, FL 32073-1654

Phone

(904) 374-1722

NPI assigned

Jan 21, 2015

Last updated

Jan 21, 2015By 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

Mr. Tamba Ngauja

Title

Executive Director

Phone

(904) 374-1722

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421798400000",
    "number": "1669861217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2822 SPOONBILL TRL",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320731654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2822 SPOONBILL TRL",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320731654",
            "telephone_number": "904-374-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE LIVING SOLUTIONS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-21",
        "last_updated": "2015-01-21",
        "status": "A",
        "authorized_official_last_name": "NGAUJA",
        "authorized_official_first_name": "TAMBA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "904-374-1722",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004282900",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012283500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Orange Park, FL
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• Home Health Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; 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.