Provider Demographics
NPI:1558061630
Name:ADULT INDEPENDENT SERVICES
Entity Type:Organization
Organization Name:ADULT INDEPENDENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-541-7765
Mailing Address - Street 1:2600 TILTON RD # 1093
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-1831
Mailing Address - Country:US
Mailing Address - Phone:954-541-7765
Mailing Address - Fax:
Practice Address - Street 1:1637 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2219
Practice Address - Country:US
Practice Address - Phone:954-309-3517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services