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General NPI Number Information
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NPI Number | 1053564492
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Entity Type | Organization
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Legal Business Name | INDEPENDENT LIVING SERVICES, LLC
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 23 FORDHAM RD
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City | ESSEX
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State | CT
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Zip | 06426-1424
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Country | US
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Telephone | 860-767-7993
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Fax | 860-767-7993
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Provider Business Mailing Address
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Address Line | 23 FORDHAM RD
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City | ESSEX
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State | CT
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Zip | 06426-1424
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Country | US
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Telephone | 860-767-7993
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Fax | 860-767-7993
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BELINDA A MASSIELLO
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Credential | HHA
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Telephone | 860-767-7993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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