Provider Demographics
NPI:1891989794
Name:RESOURCE CENTER FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:RESOURCE CENTER FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BURT
Authorized Official - Middle Name:
Authorized Official - Last Name:DANOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-797-4642
Mailing Address - Street 1:131 GENESEE STREET
Mailing Address - Street 2:PO BOX 210
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-0210
Mailing Address - Country:US
Mailing Address - Phone:315-797-4642
Mailing Address - Fax:315-797-4747
Practice Address - Street 1:131 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-2105
Practice Address - Country:US
Practice Address - Phone:315-797-4642
Practice Address - Fax:315-797-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01296684Medicaid