Provider Demographics
NPI:1306201033
Name:WRIGHT INDEPENDENT LIFE OPTIONS
Entity Type:Organization
Organization Name:WRIGHT INDEPENDENT LIFE OPTIONS
Other - Org Name:WILO NJ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-698-1188
Mailing Address - Street 1:558 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1372
Mailing Address - Country:US
Mailing Address - Phone:908-698-1188
Mailing Address - Fax:
Practice Address - Street 1:558 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1372
Practice Address - Country:US
Practice Address - Phone:908-698-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care