Provider Demographics
NPI:1811447774
Name:INDEPENDENT LIVING CENTER, INC
Entity type:Organization
Organization Name:INDEPENDENT LIVING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-7911
Mailing Address - Street 1:PO BOX 2474
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2474
Mailing Address - Country:US
Mailing Address - Phone:907-235-7911
Mailing Address - Fax:907-235-6236
Practice Address - Street 1:265 E PIONEER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7533
Practice Address - Country:US
Practice Address - Phone:907-235-7911
Practice Address - Fax:907-235-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management