Provider Demographics
NPI:1972800076
Name:IDEPENDENT DAILY LIVING SERVICES, INC
Entity Type:Organization
Organization Name:IDEPENDENT DAILY LIVING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:III
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:727-642-2699
Mailing Address - Street 1:5524 52ND AVE N
Mailing Address - Street 2:
Mailing Address - City:KENNETH CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33709-3765
Mailing Address - Country:US
Mailing Address - Phone:727-642-2699
Mailing Address - Fax:727-545-0949
Practice Address - Street 1:5524 52ND AVE N
Practice Address - Street 2:
Practice Address - City:KENNETH CITY
Practice Address - State:FL
Practice Address - Zip Code:33709-3765
Practice Address - Country:US
Practice Address - Phone:727-642-2699
Practice Address - Fax:727-545-0949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003055900Medicaid