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General NPI Number Information
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NPI Number | 1164317699
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Entity Type | Organization
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Legal Business Name | INDEPENDENT LIVING LLC
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 1128 CHARLESTON ST
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City | NORFOLK
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State | VA
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Zip | 23505-3132
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Country | US
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Telephone | 757-639-6002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64386
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City | VIRGINIA BEACH
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State | VA
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Zip | 23467-4386
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID MILLER
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Credential |
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Telephone | 757-639-6002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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