Provider Demographics
NPI:1376798009
Name:INDEPENDENT LIFE SERVICES, INC.
Entity Type:Organization
Organization Name:INDEPENDENT LIFE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-917-2034
Mailing Address - Street 1:3641 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2503
Mailing Address - Country:US
Mailing Address - Phone:480-917-2034
Mailing Address - Fax:480-917-2115
Practice Address - Street 1:3641 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2503
Practice Address - Country:US
Practice Address - Phone:480-917-2034
Practice Address - Fax:480-917-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services