Organization
INDEPENDENT GROUP HOME LIVING PROGRAM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYBETH LICTHNEGER (CFO)
(631) 878-8900
Entity
Organization
Contact information
Practice address
908 MELVILLE ESTATES, MELVILLE, NY 11747
(631) 878-8900
(631) 878-8201
Mailing address
221 N SUNRISE SERVICE RD, MANORVILLE, NY 11949-9604
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
Other
Enumeration date
03/29/2016
Last updated
03/29/2016
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