Provider Demographics
NPI:1730321126
Name:INDEPENDENT KEEPERS
Entity Type:Organization
Organization Name:INDEPENDENT KEEPERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:I
Authorized Official - Credentials:LPN
Authorized Official - Phone:251-633-2524
Mailing Address - Street 1:1110 HILLCREST RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3954
Mailing Address - Country:US
Mailing Address - Phone:251-633-2524
Mailing Address - Fax:
Practice Address - Street 1:1110 HILLCREST RD STE 2D
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3954
Practice Address - Country:US
Practice Address - Phone:251-633-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL086204305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization