OrganizationActive
Northeast Independent Living Services
NPI 1861622128 · PACE Provider Organization · Hannibal, MO
Provider details
- NPI number
- 1861622128
- Entity type
- Organization
- Primary specialty
- PACE Provider OrganizationAgencies
- Organization subpart
- No
- Authorized official
- Tara Fortner, Payroll Billing Manager(573) 221-8282
- License
- 834 (MO)
Specialties & taxonomies
Agencies
Profile Score
Detailed profile(85/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
16 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
909 Broadway
Suite 350
Hannibal, MO 63401-4249
Phone: (573) 221-8282
Fax: (573) 221-8233
Approximate (ZIP-level) locationGet directions
Mailing address
909 Broadway
Hannibal, MO 63401-4249
Other names (DBA / former)
- Doing business as
- Magnolia Garden Adult Daycare
Registry dates
- Enumerated
- 2009-07-21
- Last updated
- 2009-07-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.