Provider Demographics
NPI: | 1831635481 |
---|---|
Name: | RESOURCES FOR INDEPENDENT LIVING, INC. |
Entity Type: | Organization |
Organization Name: | RESOURCES FOR INDEPENDENT LIVING, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LISA |
Authorized Official - Middle Name: | MICHELLE |
Authorized Official - Last Name: | KILLION-SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 609-747-7745 |
Mailing Address - Street 1: | 193 N BROADWAY |
Mailing Address - Street 2: | |
Mailing Address - City: | PENNSVILLE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08070-1417 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-678-9400 |
Mailing Address - Fax: | 856-213-5427 |
Practice Address - Street 1: | 614 E LANDIS AVE |
Practice Address - Street 2: | |
Practice Address - City: | VINELAND |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08360-8027 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-825-0255 |
Practice Address - Fax: | 856-213-5427 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-01-06 |
Last Update Date: | 2024-04-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251V00000X | Agencies | Voluntary or Charitable | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | Group - Multi-Specialty |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | Group - Multi-Specialty |
No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | Group - Multi-Specialty | |
No | 372500000X | Nursing Service Related Providers | Chore Provider | Group - Multi-Specialty | |
No | 372600000X | Nursing Service Related Providers | Adult Companion | Group - Multi-Specialty | |
No | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0374717 | Medicaid |