Provider Demographics
NPI:1437386596
Name:CENTER FOR INDEPENDENT LIVING OF SOUTH JERSEY, INC.
Entity Type:Organization
Organization Name:CENTER FOR INDEPENDENT LIVING OF SOUTH JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE-BRIGGSD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-853-6490
Mailing Address - Street 1:1150 DELSEA DR
Mailing Address - Street 2:SUITE 1,
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-2225
Mailing Address - Country:US
Mailing Address - Phone:856-853-6490
Mailing Address - Fax:856-853-1466
Practice Address - Street 1:1150 DELSEA DR
Practice Address - Street 2:SUITE 1,
Practice Address - City:WESTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08093-2225
Practice Address - Country:US
Practice Address - Phone:856-853-6490
Practice Address - Fax:856-853-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management