Provider Demographics
NPI:1972628717
Name:LONG ISLAND CENTER FOR INDEPENDENT LIVING, INC.
Entity Type:Organization
Organization Name:LONG ISLAND CENTER FOR INDEPENDENT LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FISCAL MANAGEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BASELICE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:516-796-0144
Mailing Address - Street 1:3601 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE #500
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1375
Mailing Address - Country:US
Mailing Address - Phone:516-796-0144
Mailing Address - Fax:516-796-0529
Practice Address - Street 1:3601 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE #500
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1375
Practice Address - Country:US
Practice Address - Phone:516-796-0144
Practice Address - Fax:516-796-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01794738Medicaid