Provider Demographics
NPI:1336956549
Name:INDEPENDENT LIVING RESOURCE CENTER
Entity type:Organization
Organization Name:INDEPENDENT LIVING RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YILDIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-266-5022
Mailing Address - Street 1:7950 S LINCOLN ST
Mailing Address - Street 2:SUITE 111E
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2727
Mailing Address - Country:US
Mailing Address - Phone:720-379-3642
Mailing Address - Fax:720-379-3164
Practice Address - Street 1:7950 S LINCOLN ST
Practice Address - Street 2:SUITE 111E
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2727
Practice Address - Country:US
Practice Address - Phone:720-379-3642
Practice Address - Fax:720-379-3164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT LIVING RESOURCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000176801Medicaid