Provider Demographics
NPI:1922140060
Name:INDEPENDENT LIVING CHOICES
Entity Type:Organization
Organization Name:INDEPENDENT LIVING CHOICES
Other - Org Name:PRAIRIE FREEDOM CENTER FOR INDEPENDENT LIVING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-3550
Mailing Address - Street 1:4107 S CARNEGIE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2321
Mailing Address - Country:US
Mailing Address - Phone:605-362-3550
Mailing Address - Fax:605-362-3555
Practice Address - Street 1:4107 S CARNEGIE CIRCLE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2321
Practice Address - Country:US
Practice Address - Phone:605-362-3550
Practice Address - Fax:605-362-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5195020Medicaid