Provider Demographics
NPI:1508143587
Name:INDEPENDENT LIFE
Entity Type:Organization
Organization Name:INDEPENDENT LIFE
Other - Org Name:INDEPENDENT LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZLATA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUJIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-871-2273
Mailing Address - Street 1:4955 S DURANGO DR
Mailing Address - Street 2:164
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113
Mailing Address - Country:US
Mailing Address - Phone:702-871-2273
Mailing Address - Fax:
Practice Address - Street 1:4955 S DURANGO DR
Practice Address - Street 2:164
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-871-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6344PCS-0251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health