MEDICARE: INDEPENDENT LIVING RESOURCE CENTER, 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

General Provider Information

NPI Number	:	1497834667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT LIVING RESOURCE CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 6787
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65102-6787
Country	:	US
Telephone Number	:	573-556-0400
Fax Number	:	573-556-0402

Provider Business Practice Location Address
First Line	:	3620 W TRUMAN BLVD STE D
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6125
Country	:	US
Telephone Number	:	573-556-0400
Fax Number	:	573-556-0402

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. STEPHANIE COX
Credential	:	MSW
Telephone Number	:	573-556-0400

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	01/15/2008

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