Healthcare Provider Details

I. General information

NPI: 1902250608
Provider Name (Legal Business Name): INDEPENDENT LIFE HOME CARE & STAFFING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OLD ORCHARD LN
MOUNTAIN TOP PA
18707-1741
US

IV. Provider business mailing address

2 OLD ORCHARD LN
MOUNTAIN TOP PA
18707-1741
US

V. Phone/Fax

Practice location:
  • Phone: 570-793-4280
  • Fax:
Mailing address:
  • Phone: 570-793-4280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GERALDINE VICKERS
Title or Position: DIRECTOR/CEO
Credential: CRNP
Phone: 570-793-4280