Organization
INDEPENDENT LIFESTYLES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER A HERMANSON (ADMINISTRATIVE DIRECTOR)
(320) 281-2027
Entity
Organization
Contact information
Practice address
215 N BENTON DR, SAUK RAPIDS, MN 56379-1530
(320) 529-9000
(320) 529-0747
Mailing address
215 N BENTON DR, SAUK RAPIDS, MN 56379-1530
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1068099
MN DEPT. OF HUMAN SERVICES (DHS)- 245D LICENSE
MN
01
—
A114035300
MN DEPT. OF HUMAN SERVICES (DHS) UMPI # FOR WAIVER SERVICES
MN
01
—
A558653000
MN DEPT. OF HUMAN SERVICES (DHS) UMPI # FOR PCA CHOICE
MN
01
—
A768487000
MN DEPT. OF HUMAN SERVICES (DHS) UMPI # FOR CASE MGMT.
MN
Enumeration date
02/11/2020
Last updated
12/03/2021
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