MEDICARE: INDEPENDENT LIVING SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1487867123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT LIVING SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 6395
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83707-6395
Country	:	US
Telephone Number	:	208-344-2807
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 N FIVE MILE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5408
Country	:	US
Telephone Number	:	208-344-2807
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	H. MICHAEL DAY
Credential	:
Telephone Number	:	208-375-5155

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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