Provider Demographics
NPI:1720478027
Name:INDEPENDENCE & COMFORT LIVING
Entity Type:Organization
Organization Name:INDEPENDENCE & COMFORT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:HAMZA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-766-1544
Mailing Address - Street 1:2360 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-8702
Mailing Address - Country:US
Mailing Address - Phone:415-766-1544
Mailing Address - Fax:
Practice Address - Street 1:2360 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-8702
Practice Address - Country:US
Practice Address - Phone:415-766-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3743320253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care