MEDICARE: INDEPENDENCY LLC

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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NA	OTHER	OH	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801353826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCY LLC

Provider Business Mailing Address
First Line	:	300 COOPER ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1604
Country	:	US
Telephone Number	:	740-358-7491
Fax Number	:	740-326-6162

Provider Business Practice Location Address
First Line	:	300 COOPER ST
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1604
Country	:	US
Telephone Number	:	740-358-7491
Fax Number	:	740-326-6162

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. CHRISTIAN JACOB HARDIN
Credential	:
Telephone Number	:	740-358-7491

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	01/16/2025

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