Provider Demographics
NPI:1699380717
Name:INDEPENDENT LIVING OF OHIO, INC
Entity type:Organization
Organization Name:INDEPENDENT LIVING OF OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ACKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-323-5856
Mailing Address - Street 1:1610 MITCHELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-3416
Mailing Address - Country:US
Mailing Address - Phone:937-323-5856
Mailing Address - Fax:937-323-8408
Practice Address - Street 1:1610 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-3416
Practice Address - Country:US
Practice Address - Phone:937-323-5856
Practice Address - Fax:937-323-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2163528Medicaid