Provider Demographics
NPI:1851458301
Name:BOONE COUNTY INDEPENDENT LIVING, INC.
Entity Type:Organization
Organization Name:BOONE COUNTY INDEPENDENT LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KORIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-741-6909
Mailing Address - Street 1:PO BOX 2300
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-2300
Mailing Address - Country:US
Mailing Address - Phone:870-741-6909
Mailing Address - Fax:870-741-4549
Practice Address - Street 1:206 S CHERRY ST STE D
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5044
Practice Address - Country:US
Practice Address - Phone:870-741-6909
Practice Address - Fax:870-741-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities