Provider Demographics
NPI:1467664540
Name:SUPPORTIVE INDEPENDENT LIVING CORP
Entity Type:Organization
Organization Name:SUPPORTIVE INDEPENDENT LIVING CORP
Other - Org Name:COMFORT KEEPERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KORBIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LLM
Authorized Official - Phone:631-369-6080
Mailing Address - Street 1:31 MAIN ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-369-6080
Mailing Address - Fax:631-369-6085
Practice Address - Street 1:31 MAIN ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-369-6080
Practice Address - Fax:631-369-6085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health