Organization
INSTITUTE FOR COMMUNITY LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHEVON ELIZABETH VASSOR (SENIOR CASE MANAGER)
(718) 290-2410
Entity
Organization
Contact information
Practice address
198 LINDEN BLVD, BROOKLYN, NY 11226-3627
(718) 290-2410
(718) 856-6867
Mailing address
198 LINDEN BLVD, BROOKLYN, NY 11226-3627
(718) 856-6867
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01305004
—
NY
Enumeration date
10/02/2008
Last updated
10/02/2008
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