Provider Demographics
NPI:1922120252
Name:INDEPENDENT LIVING, INC.
Entity Type:Organization
Organization Name:INDEPENDENT LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-565-1162
Mailing Address - Street 1:5 WASHINGTON TER
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5338
Mailing Address - Country:US
Mailing Address - Phone:845-565-1162
Mailing Address - Fax:845-565-0567
Practice Address - Street 1:5 WASHINGTON TER
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5338
Practice Address - Country:US
Practice Address - Phone:845-565-1162
Practice Address - Fax:845-565-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01738930Medicaid