Provider Demographics
NPI:1427440650
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 1:1720 LOUISIANA BLVD., NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7070
Mailing Address - Country:US
Mailing Address - Phone:505-266-5022
Mailing Address - Fax:505-266-0294
Practice Address - Street 1:1720 LOUISIANA BLVD., NE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7070
Practice Address - Country:US
Practice Address - Phone:505-266-5022
Practice Address - Fax:505-266-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM78905737Medicaid