Provider Demographics
NPI:1194906677
Name:INDEPENDENT LIVING CENTERS, INC.
Entity type:Organization
Organization Name:INDEPENDENT LIVING CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-643-4443
Mailing Address - Street 1:800 N RAINBOW BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1193
Mailing Address - Country:US
Mailing Address - Phone:702-643-4443
Mailing Address - Fax:702-878-8761
Practice Address - Street 1:210 GOLD CREEK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-8405
Practice Address - Country:US
Practice Address - Phone:775-297-3387
Practice Address - Fax:702-878-8761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances