Organization
INDEPENDENCE LIVING SOLUTIONS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TAMBA NGAUJA (EXECUTIVE DIRECTOR)
(904) 374-1722
Entity
Organization
Contact information
Practice address
2822 SPOONBILL TRL, ORANGE PARK, FL 32073-1654
(904) 374-1722
Mailing address
2822 SPOONBILL TRL, ORANGE PARK, FL 32073-1654
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004282900
—
FL
05
—
012283500
—
FL
Enumeration date
01/21/2015
Last updated
01/21/2015
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