Organization · Type 2 NPI
Independent Group Home Living
Intellectual Disabilities Intermediate Care Facility · Speonk, NY
NPI number
1801069372
Active
Practice location
114 N Phillips Ave
Speonk, NY 11972
Fax (631) 878-8201
Mailing address
221 N Sunrise Service Rd
Manorville, NY 11949-9604
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | None listed |
| Intellectual Disabilities Intermediate Care Facility Primary | 315P00000X | None listed |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
About NPI 1801069372
Independent Group Home Living's National Provider Identifier is 1801069372, issued on Apr 7, 2008. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Speonk, NY. The record was last updated on Apr 7, 2008.