Provider Demographics
NPI:1053564492
Name:INDEPENDENT LIVING SERVICES, LLC
Entity type:Organization
Organization Name:INDEPENDENT LIVING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MASSIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:HHA
Authorized Official - Phone:860-767-7993
Mailing Address - Street 1:23 FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1424
Mailing Address - Country:US
Mailing Address - Phone:860-767-7993
Mailing Address - Fax:860-767-7993
Practice Address - Street 1:23 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1424
Practice Address - Country:US
Practice Address - Phone:860-767-7993
Practice Address - Fax:860-767-7993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health