Provider Demographics
NPI:1689039984
Name:INDEPENDENT LIFE, LLC
Entity Type:Organization
Organization Name:INDEPENDENT LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-662-5556
Mailing Address - Street 1:111 W PORT PLZ
Mailing Address - Street 2:600
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3011
Mailing Address - Country:US
Mailing Address - Phone:314-662-5556
Mailing Address - Fax:866-597-4551
Practice Address - Street 1:111 W PORT PLZ
Practice Address - Street 2:600
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3011
Practice Address - Country:US
Practice Address - Phone:314-662-5556
Practice Address - Fax:866-597-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty