Organization
INDEPENDENT LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY SCOTT TILLMAN (ADMINISTRATOR/ MANAGER)
(626) 863-6349
Entity
Organization
Contact information
Practice address
128 N 4TH ST, ALHAMBRA, CA 91801-3410
(626) 656-6200
Mailing address
128 N 4TH ST, ALHAMBRA, CA 91801-3410
(626) 863-6349
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/27/2018
Last updated
11/27/2018
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