Provider Demographics
NPI:1023199486
Name:SOUTHERN INDIANA CENTER FOR INDEPENDENT LIVING, INC
Entity Type:Organization
Organization Name:SOUTHERN INDIANA CENTER FOR INDEPENDENT LIVING, INC
Other - Org Name:SICIL HOME CARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-277-9626
Mailing Address - Street 1:651 X ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-1943
Mailing Address - Country:US
Mailing Address - Phone:812-277-9626
Mailing Address - Fax:812-277-9628
Practice Address - Street 1:157 TEKE BURTON DR
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:IN
Practice Address - Zip Code:47446-1208
Practice Address - Country:US
Practice Address - Phone:812-849-6000
Practice Address - Fax:812-849-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities