Provider Demographics
NPI:1790031219
Name:COALITION FOR INDEPENDENT LIVING OPTIONS, INC
Entity Type:Organization
Organization Name:COALITION FOR INDEPENDENT LIVING OPTIONS, INC
Other - Org Name:CILO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:T
Authorized Official - Last Name:COUSMINER
Authorized Official - Suffix:
Authorized Official - Credentials:ESQUIRE
Authorized Official - Phone:561-966-4288
Mailing Address - Street 1:6800 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3310
Mailing Address - Country:US
Mailing Address - Phone:561-966-4288
Mailing Address - Fax:561-641-6619
Practice Address - Street 1:6800 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3310
Practice Address - Country:US
Practice Address - Phone:561-966-4288
Practice Address - Fax:561-641-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002045200Medicaid