Provider Demographics
NPI:1427096916
Name:INDEPENDANT LIFE STYLES
Entity type:Organization
Organization Name:INDEPENDANT LIFE STYLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-846-7510
Mailing Address - Street 1:4880 S AMHERST HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-2478
Mailing Address - Country:US
Mailing Address - Phone:434-846-7510
Mailing Address - Fax:434-846-7189
Practice Address - Street 1:4880 S AMHERST HWY
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2478
Practice Address - Country:US
Practice Address - Phone:434-846-7510
Practice Address - Fax:434-846-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009120645Medicaid
VA4600550001Medicare NSC