Provider Demographics
NPI:1205033438
Name:INDEPENDENT LIVING, INC.
Entity Type:Organization
Organization Name:INDEPENDENT LIVING, INC.
Other - Org Name:SEGOE GARDENS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVANNONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-274-7900
Mailing Address - Street 1:2970 CHAPEL VALLEY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7424
Mailing Address - Country:US
Mailing Address - Phone:608-274-7900
Mailing Address - Fax:608-274-9181
Practice Address - Street 1:606 N SEGOE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3110
Practice Address - Country:US
Practice Address - Phone:608-204-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT LIVING, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-29
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0013225OtherSTATE ISSUED REGISTRATION #
WI0009246OtherSTATE ISSUED FACILITY #