NPI 1861622128

Northeast Independent Living Services

Organisation PACE Provider Organization Hannibal, MO

Practice location

Address: 909 Broadway Suite 350, Hannibal, MO 63401-4249
Phone: (573) 221-8282
Fax: (573) 221-8233

Authorised official

Name: Tara Fortner
Title: Payroll Billing Manager
Phone: (573) 221-8282

Registered specialties

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X Licence 834 (MO)

Other Program of All-Inclusive Care for the Elderly (PACE) Provider Organization providers in Missouri →

Registry record

NPI: 1861622128
Entity type: Organization
NPI issued: 21 Jul 2009
Record last updated: 21 Jul 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.