Provider Demographics
NPI:1992186449
Name:COMMUNITY ACTION FOR INDEPENDENT LIVING, INC.
Entity Type:Organization
Organization Name:COMMUNITY ACTION FOR INDEPENDENT LIVING, INC.
Other - Org Name:INTERSERV SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIFABIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-564-7557
Mailing Address - Street 1:1 CORNELL PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3561
Mailing Address - Country:US
Mailing Address - Phone:973-564-7557
Mailing Address - Fax:973-467-4255
Practice Address - Street 1:34 S CENTRE ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2608
Practice Address - Country:US
Practice Address - Phone:973-763-7248
Practice Address - Fax:973-821-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH201320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities