Provider Demographics
NPI:1114379252
Name:THE INDEPENDENT LIVING CENTER, INC.
Entity type:Organization
Organization Name:THE INDEPENDENT LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STORMI
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-659-8086
Mailing Address - Street 1:2639 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4337
Mailing Address - Country:US
Mailing Address - Phone:417-659-8086
Mailing Address - Fax:417-659-8087
Practice Address - Street 1:2639 E 34TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4337
Practice Address - Country:US
Practice Address - Phone:417-659-8086
Practice Address - Fax:417-659-8087
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE INDEPENDENT LIVING CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-12
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty