Provider Demographics
NPI:1083764724
Name:INDEPENDENT LIVING SYSTEMS LLC
Entity Type:Organization
Organization Name:INDEPENDENT LIVING SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT GENERAL COUNSEL & PRIVACY
Authorized Official - Prefix:
Authorized Official - First Name:SUSY
Authorized Official - Middle Name:
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-918-5857
Mailing Address - Street 1:4601 NW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6449
Mailing Address - Country:US
Mailing Address - Phone:305-262-1292
Mailing Address - Fax:305-675-7825
Practice Address - Street 1:4601 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-6449
Practice Address - Country:US
Practice Address - Phone:786-918-5857
Practice Address - Fax:305-675-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 251X00000X
FLCONTRACTUAL SERVICES251B00000X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No251X00000XAgenciesSupports Brokerage
No332U00000XSuppliersHome Delivered Meals