Provider Demographics
NPI:1588809867
Name:INDEPENDENCE GROUP
Entity Type:Organization
Organization Name:INDEPENDENCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:DEBOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-464-9404
Mailing Address - Street 1:2233 PALM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2438
Mailing Address - Country:US
Mailing Address - Phone:407-464-9404
Mailing Address - Fax:407-464-9404
Practice Address - Street 1:2233 PALM VIEW DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-2438
Practice Address - Country:US
Practice Address - Phone:407-464-9404
Practice Address - Fax:407-464-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687866196Medicaid
FL687866198Medicaid