MEDICARE: INDEPENDENCE UNLIMITED 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	251E00000X	Home Health Agency	2301048	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2301048	OTHER	OH	ODMRDD PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366563298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE UNLIMITED INC.

Provider Business Mailing Address
First Line	:	460 LOGAN ST S
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9651
Country	:	US
Telephone Number	:	740-987-8123
Fax Number	:	740-987-8393

Provider Business Practice Location Address
First Line	:	460 LOGAN ST S
Second Line	:
City	:	JUNCTION CITY
State	:	OH
Zip	:	43748-9651
Country	:	US
Telephone Number	:	740-987-8123
Fax Number	:	740-987-8393

Authorized Official
Title or Position	:	CEO
Name	:	BRIDGETT ANN CANTER
Credential	:
Telephone Number	:	740-987-8123

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/22/2020

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