Healthcare Provider Details

I. General information

NPI: 1114431798
Provider Name (Legal Business Name): INDEPENDENT LIVING SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2017
Last Update Date: 11/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 N PULASKI RD
CHICAGO IL
60646-4511
US

IV. Provider business mailing address

6327 N PULASKI RD
CHICAGO IL
60646-4511
US

V. Phone/Fax

Practice location:
  • Phone: 773-478-8450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. JEREMY HANSON
Title or Position: PRESIDENT
Credential:
Phone: 773-478-8450