Northeast Independent Living Services

NPI #1861622128 in Hannibal, Missouri

Provider Information

NPI Number: 1861622128
Entity Type: Organization
Organization Name: Northeast Independent Living Services
Primary Specialty: Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
Enumeration Date: Jul 21, 2009
Last Updated: Jul 21, 2009

Practice Location

Address: 909 BROADWAY
Address 2: SUITE 350
City: Hannibal
State: Missouri
ZIP Code: 63401-4249
Phone: (573) 221-8282

Authorized Official

Name: TARA FORTNER
Title: PAYROLL BILLING MANAGER
Phone: (573) 221-8282

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization	251T00000X	Primary

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