Provider Demographics
NPI:1760697288
Name:INDEPENDENT LIVING CENTER, INC.
Entity Type:Organization
Organization Name:INDEPENDENT LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MEUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-841-0591
Mailing Address - Street 1:401 VETERANS MEMORIAL BOULEVAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2957
Mailing Address - Country:US
Mailing Address - Phone:504-841-0591
Mailing Address - Fax:504-841-0595
Practice Address - Street 1:401 VETERANS MEMORIAL BOULEVAD
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2957
Practice Address - Country:US
Practice Address - Phone:504-841-0591
Practice Address - Fax:504-841-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1171379Medicaid
LA1923796Medicaid
LA19662720Medicaid