NORTHEAST INDEPENDENT LIVING SERVICES (NPI# 1861622128) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861622128 |
| Entity Type | Organization |
| Organization Name | NORTHEAST INDEPENDENT LIVING SERVICES |
| Other Organization Name | MAGNOLIA GARDEN ADULT DAYCARE |
| Practice Address |
909 Broadway Suite 350 Hannibal MO 63401-4249 |
| Practice Telephone | 5732218282 |
| Practice Fax Number | 5732218233 |
| Mailing Telephone | 5732218282 |
| Mailing Fax Number | 5732218233 |
| Enumeration Date | 2009-07-21 |
| Last Update Date | 2009-07-21 |
| Authorized Official Name | TARA FORTNER (PAYROLL BILLING MANAGER) |
| Authorized Official Telephone | 5732218282 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251T00000X | PACE Provider Organization | 834 | MO | Agencies |
| Other Name | Type Code |
|---|---|
| Magnolia Garden Adult Daycare | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457528085 | Northeast Independent Living Services | Chore Provider | 909 Broadway Ste 350, Hannibal, MO 63401-4253 | 2008-05-13 |
| 1952426496 | Northeast Independent Living Services | Technician | 142 Jaycee Dr, Hannibal, MO 63401-3673 | 2007-03-21 |
| 1790948958 | Northeast Independent Living Services | Nursing Care | 142 Jaycee Dr, Hannibal, MO 63401-3673 | 2008-07-08 |
| Street Address |
909 BROADWAY SUITE 350 |
| City | HANNIBAL |
| State | MO |
| Zip Code | 63401-4249 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255981064 | Amanda Lynn Jennings | Nurse Practitioner | Hannibal Clinic, 100 Medical Drive, Hannibal, MO 63401 | 2019-09-13 |
| 1316452295 | Hannibal Regional Healthcare System, Inc | Hospice Care, Community Based | 6401 Hwy Mm, Hannibal, MO 63401 | 2017-12-13 |
| 1932614351 | Sidney M Johnson | Counselor | 1221 Broadway St, Hannibal, MO 63401 | 2017-12-07 |
| 1316467210 | Jessica Baker | Counselor | 4355 Paris Gravel Road, Hannibal, MO 63401 | 2017-06-21 |
| 1346787066 | Hands Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17 Settlerstrail, Hannibal, MO 63401 | 2017-01-20 |
| 1134571672 | Pamela Barrigar | Social Worker | 4600 Mcmasters Ave, Hannibal, MO 63401 | 2016-07-08 |
| 1639540677 | Jessica Murfin | Speech-Language Pathologist | 544 N Veterans Rd, Hannibal, MO 63401 | 2015-10-16 |
| 1366835639 | Cpo Services, Inc. | Prosthetic/Orthotic Supplier | 8965 Highway 36 Ste 3, Hannibal, MO 63401 | 2015-03-11 |
| 1639324254 | Hannibal Medical Supplies, LLC | Durable Medical Equipment & Medical Supplies | 118 Steam Boat Bend, Hannibal, MO 63401 | 2008-11-24 |
| 1780856112 | Barbara Belle Smith | Social Worker | 3700 Hwy Mm, Hannibal, MO 63401 | 2008-03-26 |
| Find all providers in zip 63401 | ||||
| Taxonomy Code | 251T00000X |
| Grouping | Agencies |
| Classification | PACE Provider Organization |
| A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services). The following characteristics also apply to a PACE organization. It must: have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights. |
| Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184283004 | Cfc Solutions Inc. | PACE Provider Organization | 6589 N Oak Trfy, Gladstone, MO 64118-3330 | 2019-06-13 |
| 1144595588 | Love Smiling Faces Adult Day Care, LLC | PACE Provider Organization | 9738 Lackland Rd, Overland, MO 63114-3424 | 2012-03-19 |
| 1124358114 | Great Day Adult Daycare | PACE Provider Organization | 7091 Olive Blvd, Saint Louis, MO 63130-2347 | 2010-01-13 |
| 1508034117 | Sunshine Adult Day Care Facility | PACE Provider Organization | 6207 N Lindbergh Blvd, Hazelwood, MO 63042-2817 | 2008-02-16 |
| 1881890671 | The Outreach Center of Christ The Savior | PACE Provider Organization | 3904 Delmar Blvd, Saint Louis, MO 63108-3502 | 2007-06-27 |
| 1912073206 | Alexian Brothers Community Services of St. Louis | PACE Provider Organization | 3900 S Grand Blvd, Saint Louis, MO 63118-3414 | 2006-11-28 |
Please comment or provide details below to improve the information on NORTHEAST INDEPENDENT LIVING SERVICES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.