Organization
INDEPENDENT LIVING RESOURCES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHIE KNOBLE-IVERSON (EXECUTIVE DIRECTOR)
(608) 787-1111
Entity
Organization
Contact information
Practice address
4439 MORMON COULEE RD, LA CROSSE, WI 54601-8220
(608) 787-1111
(608) 787-1114
Mailing address
4439 MORMON COULEE RD, LA CROSSE, WI 54601-8220
(608) 787-1111
(608) 787-1114
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43090600
—
WI
05
—
43106600
—
WI
Enumeration date
05/02/2007
Last updated
04/04/2008
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