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Organization
NORTHEAST INDEPENDENT LIVING SERVICES
Active
Organization
NORTHEAST INDEPENDENT LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA FORTNER (FINANCE DIRECTOR)
(573) 221-8282
Entity
Organization
Contact information
Practice address
4500 PARIS GRAVEL RD, HANNIBAL, MO 63401-5422
(573) 221-8282
(573) 221-9445
Mailing address
4500 PARIS GRAVEL RD, HANNIBAL, MO 63401-5422
(573) 221-8282
(573) 221-9445
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
372500000X
Chore Provider
—
—
376J00000X
Homemaker
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266213701
—
MO
05
—
286213707
—
MO
Enumeration date
05/13/2008
Last updated
03/08/2023
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