MEDICARE: EASY LIVING 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	1504-9053	MO

General Provider Information

NPI Number	:	1699803965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASY LIVING INC.

Provider Business Mailing Address
First Line	:	110 N RANGE LINE RD
Second Line	:	SUITE 202
City	:	JOPLIN
State	:	MO
Zip	:	64801-1602
Country	:	US
Telephone Number	:	417-626-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3061 S FORT AVE STE C
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-4257
Country	:	US
Telephone Number	:	417-881-8033
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANNA SMITH
Credential	:
Telephone Number	:	417-626-2600

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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Directions to “EASY LIVING INC. ” Practice Location

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