Provider Demographics
NPI:1164152765
Name:INDEPENDENT LIVING SOLUTIONS INC.
Entity Type:Organization
Organization Name:INDEPENDENT LIVING SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-463-8200
Mailing Address - Street 1:6225 W 48TH AVE UNIT 108
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3678
Mailing Address - Country:US
Mailing Address - Phone:303-463-8200
Mailing Address - Fax:
Practice Address - Street 1:6225 W 48TH AVE UNIT 108
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3678
Practice Address - Country:US
Practice Address - Phone:303-463-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty