Organization
INDEPENDENT GROUP HOME LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER W STOCKTON (C.E.O.)
(631) 878-8900
Entity
Organization
Contact information
Practice address
133 SHORE RD W, MOUNT SINAI, NY 11766-1237
(631) 878-8900
(631) 878-8201
Mailing address
221 N SUNRISE SERVICE RD, MANORVILLE, NY 11949-9604
(631) 878-8900
(631) 878-8201
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00519026
—
NY
Enumeration date
04/07/2008
Last updated
04/07/2008
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