Provider Demographics
NPI:1902920440
Name:ASSISTED LIVING SERVICES LLC
Entity Type:Organization
Organization Name:ASSISTED LIVING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER - PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPNP
Authorized Official - Phone:812-246-5934
Mailing Address - Street 1:3411 MEYERS GRV
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9155
Mailing Address - Country:US
Mailing Address - Phone:812-246-5934
Mailing Address - Fax:
Practice Address - Street 1:3411 MEYERS GRV
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-9155
Practice Address - Country:US
Practice Address - Phone:812-246-5934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services