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NORTHEAST INDEPENDENT LIVING SERVICES
4500 PARIS GRAVEL RD
HANNIBAL, MO63401-5422
 Phone: 573-221-8282
 Fax: 573-221-9445
 Website:
Indicates primary specialty

NPI Profile & details for NORTHEAST INDEPENDENT LIVING SERVICES

NPI Number 1457528085
LBN Legal business name NORTHEAST INDEPENDENT LIVING SERVICES
Authorized official TARA FORTNER - (FINANCE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 05/13/2008
Last updated 03/08/2023 - About 3 years ago
Identifiers
MO Medicaid 266213701
MO Medicaid 286213707
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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