=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134126758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDEPENDENCE GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2005
-----------------------------------------------------
Last Update Date | 12/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2233 PALM VIEW DR
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32712-2438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-464-9404
-----------------------------------------------------
Fax | 407-464-9404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2233 PALM VIEW DR
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32712-2438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-464-9404
-----------------------------------------------------
Fax | 407-464-9404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. LAURA KATHRYN DEBOWER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-464-9404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------