Organization
NORTHEAST INDEPENDENT LIVING SERVICES
Active
Other names
Magnolia Garden Adult Daycare
Organization subpart
No
Provider details
NPI number
Authorized official
TARA FORTNER (PAYROLL BILLING MANAGER)
(573) 221-8282
Entity
Organization
Contact information
Practice address
909 BROADWAY, SUITE 350, HANNIBAL, MO 63401-4249
(573) 221-8282
(573) 221-8233
Mailing address
909 BROADWAY, SUITE 350, HANNIBAL, MO 63401-4249
(573) 221-8282
(573) 221-8233
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
834
MO
Other
Enumeration date
07/21/2009
Last updated
07/21/2009
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