Organization
CENTER FOR INDEPENDENT LIVING OF CENTRAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOTIS W. BRADDY (EXECUTIVE DIRECTOR)
(717) 731-1900
Entity
Organization
Contact information
Practice address
207 HOUSE AVE, SUITE 107, CAMP HILL, PA 17011-2308
(717) 731-1900
Mailing address
207 HOUSE AVE, SUITE 107, CAMP HILL, PA 17011-2308
(717) 731-1900
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003963-0005
—
PA
05
—
100003963-0008
—
PA
05
—
100003963-0010
—
PA
05
—
100003963-0012
—
PA
Enumeration date
02/06/2007
Last updated
08/22/2020
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