Provider Demographics
NPI:1770829624
Name:ROCKLAND INDEPENDENT LIVING CENTER, INC.
Entity Type:Organization
Organization Name:ROCKLAND INDEPENDENT LIVING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXEC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-624-1366
Mailing Address - Street 1:873 ROUTE 45
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1116
Mailing Address - Country:US
Mailing Address - Phone:845-624-1366
Mailing Address - Fax:845-624-1369
Practice Address - Street 1:873 ROUTE 45
Practice Address - Street 2:SUITE 108
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1116
Practice Address - Country:US
Practice Address - Phone:845-624-1366
Practice Address - Fax:845-624-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666031Medicaid