Provider Demographics
NPI:1962794925
Name:LIVING INDEPENDENT SERVICES
Entity type:Organization
Organization Name:LIVING INDEPENDENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TARGET CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-251-1369
Mailing Address - Street 1:P.O. BOX 328
Mailing Address - Street 2:706 N BIRCH ST
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0328
Mailing Address - Country:US
Mailing Address - Phone:316-251-1369
Mailing Address - Fax:620-855-2221
Practice Address - Street 1:706 N BIRCH ST
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835
Practice Address - Country:US
Practice Address - Phone:316-251-1369
Practice Address - Fax:620-855-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty