Provider Demographics
NPI:1912172974
Name:INDEPENDENCE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:INDEPENDENCE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HANRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-437-8337
Mailing Address - Street 1:1 RICHMOND SQ STE 160E
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5158
Mailing Address - Country:US
Mailing Address - Phone:401-437-8337
Mailing Address - Fax:401-369-7818
Practice Address - Street 1:1 RICHMOND SQ STE 160E
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5158
Practice Address - Country:US
Practice Address - Phone:401-437-8337
Practice Address - Fax:401-369-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health