Provider Demographics
NPI:1679767099
Name:INDEPENDENCE, INC.
Entity Type:Organization
Organization Name:INDEPENDENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORHONDA
Authorized Official - Middle Name:DAWSON
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:901-312-5600
Mailing Address - Street 1:119 S MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3647
Mailing Address - Country:US
Mailing Address - Phone:901-312-5600
Mailing Address - Fax:901-312-5605
Practice Address - Street 1:119 S MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3647
Practice Address - Country:US
Practice Address - Phone:901-312-5600
Practice Address - Fax:901-312-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000043251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health