Provider Demographics
NPI:1033408075
Name:MIDWEST INDEPENDENT LIVING SERVICES, LLC
Entity Type:Organization
Organization Name:MIDWEST INDEPENDENT LIVING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-456-8064
Mailing Address - Street 1:809 EAST MAIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011
Mailing Address - Country:US
Mailing Address - Phone:952-456-8064
Mailing Address - Fax:952-322-7167
Practice Address - Street 1:809 EAST MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011
Practice Address - Country:US
Practice Address - Phone:952-456-8064
Practice Address - Fax:952-322-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health