Organization
INSTITUTE FOR COMMUNITY LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDDIE HARDAWAY (PROGRAM DIRECTOR)
(718) 272-6025
Entity
Organization
Contact information
Practice address
2384 ATLANTIC AVE, BROOKLYN, NY 11233-3402
(718) 272-6025
Mailing address
2384 ATLANTIC AVE, BROOKLYN, NY 11233-3402
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0851641
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01305004
—
NY
Enumeration date
08/02/2013
Last updated
08/02/2013
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