Organization
CONCERN FOR INDEPENDENT LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RALPH FASANO (EXECUTIVE DIRECTOR)
(631) 758-0474
Entity
Organization
Contact information
Practice address
312 EXPRESSWAY DRIVE SOUTH, MEDFORD, NY 11763
(631) 750-2225
(631) 758-0467
Mailing address
PO BOX 358, 312 EXPRESSWAY DRIVE SOUTH, MEDFORD, NY 11763
(631) 758-0474
(631) 758-0467
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
7609432
NY
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
02/08/2007
Last updated
05/18/2016
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