Healthcare Provider Details

I. General information

NPI: 1336956549
Provider Name (Legal Business Name): INDEPENDENT LIVING RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 S LINCOLN ST SUITE 111E
LITTLETON CO
80122-2727
US

IV. Provider business mailing address

7950 S LINCOLN ST SUITE 111E
LITTLETON CO
80122-2727
US

V. Phone/Fax

Practice location:
  • Phone: 720-379-3642
  • Fax: 720-379-3164
Mailing address:
  • Phone: 720-379-3642
  • Fax: 720-379-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. GIL YILDIZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-266-5022