MEDICARE: INDEPENDENT LIVING OPTIONS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1093439911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT LIVING OPTIONS INC

Provider Business Mailing Address
First Line	:	2031 AUBURN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3024
Country	:	US
Telephone Number	:	513-241-2600
Fax Number	:	513-241-1707

Provider Business Practice Location Address
First Line	:	2031 AUBURN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3024
Country	:	US
Telephone Number	:	513-241-2600
Fax Number	:	513-241-1707

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROBERT DAVID FESTENSTEIN
Credential	:
Telephone Number	:	513-338-5100

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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