Provider Demographics
NPI:1568120129
Name:INDEPENDENT LIVING PLACEMENT INC
Entity Type:Organization
Organization Name:INDEPENDENT LIVING PLACEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALMYR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-428-4811
Mailing Address - Street 1:235 6TH ST E STE 400A
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 6TH ST E STE 400A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2073
Practice Address - Country:US
Practice Address - Phone:651-428-4811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center