Provider Demographics
NPI:1548393143
Name:INDEPENDENT LIVING RESOURCE CENTER
Entity Type:Organization
Organization Name:INDEPENDENT LIVING RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:S
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-942-6300
Mailing Address - Street 1:3033 W 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5357
Mailing Address - Country:US
Mailing Address - Phone:316-942-6300
Mailing Address - Fax:316-942-1061
Practice Address - Street 1:3033 W 2ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5357
Practice Address - Country:US
Practice Address - Phone:316-942-6300
Practice Address - Fax:316-942-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS100014380A251B00000X
KS100014380C332BC3200X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100014380CMedicaid
KS100014380AMedicaid