MEDICARE: IDEPENDENT DAILY 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	253Z00000X	In Home Supportive Care Agency		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972800076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEPENDENT DAILY LIVING SERVICES, INC

Provider Business Mailing Address
First Line	:	5524 52ND AVE N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-3765
Country	:	US
Telephone Number	:	727-642-2699
Fax Number	:	727-545-0949

Provider Business Practice Location Address
First Line	:	5524 52ND AVE N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-3765
Country	:	US
Telephone Number	:	727-642-2699
Fax Number	:	727-545-0949

Authorized Official
Title or Position	:	VP
Name	:	MR. LAWRENCE EARL GEIGER III
Credential	:	MS, CCC-SLP
Telephone Number	:	727-642-2699

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/25/2011

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