Provider Demographics
NPI:1073802013
Name:SUPPORT FOR INDEPENDENT LIVING, LLC
Entity Type:Organization
Organization Name:SUPPORT FOR INDEPENDENT LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:610-649-3148
Mailing Address - Street 1:2320 HAVERFORD RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2913
Mailing Address - Country:US
Mailing Address - Phone:610-649-3148
Mailing Address - Fax:610-649-3923
Practice Address - Street 1:2320 HAVERFORD RD
Practice Address - Street 2:SUITE 220
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2913
Practice Address - Country:US
Practice Address - Phone:610-649-3148
Practice Address - Fax:610-649-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care