Provider Demographics
NPI:1841439296
Name:@ HOME INDEPENDENCE SERVICES, LLC
Entity type:Organization
Organization Name:@ HOME INDEPENDENCE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-963-3133
Mailing Address - Street 1:158 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9342
Mailing Address - Country:US
Mailing Address - Phone:276-963-3133
Mailing Address - Fax:276-889-0350
Practice Address - Street 1:158 MEADE ST
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9342
Practice Address - Country:US
Practice Address - Phone:276-963-3133
Practice Address - Fax:276-889-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care