Provider Demographics
NPI:1790948958
Name:NORTHEAST INDEPENDENT LIVING SERVICES
Entity Type:Organization
Organization Name:NORTHEAST INDEPENDENT LIVING SERVICES
Other - Org Name:QUALITY IN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-221-8282
Mailing Address - Street 1:909 BROADWAY STE 350
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-4253
Mailing Address - Country:US
Mailing Address - Phone:573-221-8282
Mailing Address - Fax:573-221-8233
Practice Address - Street 1:4500 PARIS GRAVEL RD
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-5422
Practice Address - Country:US
Practice Address - Phone:573-221-8282
Practice Address - Fax:573-221-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care