Provider Demographics
NPI:1376916668
Name:INDEPENDENT LIVING ASSOCIATION, INC.
Entity Type:Organization
Organization Name:INDEPENDENT LIVING ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXEC. DIR. / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:718-852-2000
Mailing Address - Street 1:110 YORK ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1412
Mailing Address - Country:US
Mailing Address - Phone:718-852-2000
Mailing Address - Fax:718-852-6175
Practice Address - Street 1:110 YORK ST FL 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1412
Practice Address - Country:US
Practice Address - Phone:718-852-2000
Practice Address - Fax:718-852-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07645476315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities