Organization
THE INDEPENDENT LIVING CENTER, INC.
Active
Other names
Independent Living In-Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STORMI L. NORDSTROM (OFFICE MANAGER)
(417) 659-8086
Entity
Organization
Contact information
Practice address
2639 E 34TH ST, JOPLIN, MO 64804-4337
(417) 659-8086
(417) 649-8087
Mailing address
2639 E 34TH ST, JOPLIN, MO 64804-4337
(417) 659-8086
(417) 649-8087
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
372500000X
Chore Provider
—
MO
3747P1801X
Personal Care Attendant
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266213602
—
MO
05
—
266236108
—
MO
05
—
286236104
—
MO
Enumeration date
02/01/2007
Last updated
10/19/2022
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