Healthcare Provider Details

I. General information

NPI: 1336570118
Provider Name (Legal Business Name): INDEPENDENT LIVING SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 GARRETT WAY STE 15
POCATELLO ID
83201-5132
US

IV. Provider business mailing address

1800 GARRETT WAY STE 15
POCATELLO ID
83201-5132
US

V. Phone/Fax

Practice location:
  • Phone: 208-234-8525
  • Fax: 208-234-9827
Mailing address:
  • Phone: 208-234-8525
  • Fax: 208-234-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JANET D BOYCE
Title or Position: DIRECTOR
Credential:
Phone: 208-234-8525