NPIMap

Organization Active NPI

Northeast Independent Living Services

Doing business as Magnolia Garden Adult Daycare

  • PACE Provider Organization
  • Hannibal, MO
National Provider Identifier
1861622128
Registry record updated Jul 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
License
834 Issued in MO
Legal business name
NORTHEAST INDEPENDENT LIVING SERVICES
Doing business as
Magnolia Garden Adult Daycare
Practice address
909 Broadway
Suite 350
Hannibal, MO 63401-4249
Phone
(573) 221-8282
Fax
(573) 221-8233
NPI assigned
Jul 21, 2009
Last updated
Jul 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2009

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

Authorized official

Name
Tara Fortner
Title
Payroll Billing Manager
Phone
(573) 221-8282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X 834 MO Primary

Addresses

Primary practice location

909 Broadway
Suite 350
Hannibal, MO 63401-4249

Mailing address

909 Broadway
Suite 350
Hannibal, MO 63401-4249
Phone (573) 221-8282

Other names 1

  • Magnolia Garden Adult Daycare Doing business as

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

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": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248134400000",
    "number": "1861622128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 BROADWAY",
            "address_2": "SUITE 350",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634014249",
            "telephone_number": "573-221-8282",
            "fax_number": "573-221-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 BROADWAY",
            "address_2": "SUITE 350",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634014249",
            "telephone_number": "573-221-8282",
            "fax_number": "573-221-8233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST INDEPENDENT LIVING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2009-07-21",
        "status": "A",
        "authorized_official_last_name": "FORTNER",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "PAYROLL BILLING MANAGER",
        "authorized_official_telephone_number": "573-221-8282"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "MO",
            "license": "834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magnolia Garden Adult Daycare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 21, 2009; 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.