Provider Demographics
NPI:1487867123
Name:INDEPENDENT LIVING SERVICES, INC.
Entity Type:Organization
Organization Name:INDEPENDENT LIVING SERVICES, INC.
Other - Org Name:ILS - FIVE MILE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:H.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-5155
Mailing Address - Street 1:PO BOX 6395
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-6395
Mailing Address - Country:US
Mailing Address - Phone:208-344-2807
Mailing Address - Fax:
Practice Address - Street 1:1736 N FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5408
Practice Address - Country:US
Practice Address - Phone:208-344-2807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities