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General NPI Number Information
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NPI Number | 1639336340
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Entity Type | Organization
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Legal Business Name | INDEPENDENT LIVING SERVICES, INC. (ILS)
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 158 E VIENNA ST
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City | ANNA
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State | IL
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Zip | 62906-1840
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Country | US
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Telephone | 618-833-5070
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Fax | 618-833-4993
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Provider Business Mailing Address
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Address Line | 158 E VIENNA ST
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City | ANNA
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State | IL
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Zip | 62906-1840
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Country | US
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Telephone | 618-833-5070
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Fax | 618-833-4993
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | MR. JAMES A. KELLER
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Credential |
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Telephone | 618-833-5070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 94S218
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License Number State | IL
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