Provider Demographics
NPI:1508564493
Name:INDEPENDENCE SKILLED CARE, LLC.
Entity Type:Organization
Organization Name:INDEPENDENCE SKILLED CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLETIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:CLENDINEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-227-6468
Mailing Address - Street 1:8000 NISKY CENTER
Mailing Address - Street 2:SUITE 16A
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-693-6005
Mailing Address - Fax:
Practice Address - Street 1:8000 NISKY CENTER
Practice Address - Street 2:SUITE 16A
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-693-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENCE HOME HEALTH HOLDINGS, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health