Provider Demographics
NPI:1730312935
Name:LIVING INDEPENDENCE NETWORK CORPORATION
Entity Type:Organization
Organization Name:LIVING INDEPENDENCE NETWORK CORPORATION
Other - Org Name:LINC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-336-3335
Mailing Address - Street 1:1878 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-3142
Mailing Address - Country:US
Mailing Address - Phone:208-336-3335
Mailing Address - Fax:208-384-5037
Practice Address - Street 1:1878 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3142
Practice Address - Country:US
Practice Address - Phone:208-336-3335
Practice Address - Fax:208-384-5037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805425200Medicaid