OrganizationActive
Northeast Independent Living Services
NPI 1861622128 · PACE Provider Organization · Hannibal, MO
Northeast Independent Living Services is a PACE Provider Organization organization in Hannibal, MO (NPI 1861622128).
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
17 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
Frequently asked questions
- What is Northeast Independent Living Services's NPI number?
- Northeast Independent Living Services's National Provider Identifier (NPI) is 1861622128, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Northeast Independent Living Services?
- Northeast Independent Living Services is classified in the NPPES registry as PACE Provider Organization (Agencies).
- Where is Northeast Independent Living Services located?
- Northeast Independent Living Services's practice location on file with NPPES is 909 Broadway, Hannibal, MO 63401-4249.
- What is Northeast Independent Living Services's phone number?
- The practice phone number listed in the NPPES registry for Northeast Independent Living Services is (573) 221-8282.
- Who is the authorized official for Northeast Independent Living Services?
- The authorized official listed on Northeast Independent Living Services's NPPES record is Tara Fortner, Payroll Billing Manager. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Northeast Independent Living Services's NPI active?
- Yes — Northeast Independent Living Services's NPI (1861622128) is active in the NPPES registry as of the last update on 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.