Healthcare Provider Details

I. General information

NPI: 1942696612
Provider Name (Legal Business Name): INDEPENDENT SECURE LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 S CONGRESS AVE SUITE 103
DELRAY BEACH FL
33445-6300
US

IV. Provider business mailing address

7431 W ATLANTIC AVE STE 34 SUITE 121
DELRAY BEACH FL
33446-3505
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-6327
  • Fax: 866-618-6094
Mailing address:
  • Phone: 561-900-3627
  • Fax: 866-618-6094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG M. BASS
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 401-318-0058