Provider Demographics
NPI:1295981223
Name:ASSISTED INDEPENDENCE SERVICES, INC,
Entity type:Organization
Organization Name:ASSISTED INDEPENDENCE SERVICES, INC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-922-4100
Mailing Address - Street 1:3455 STATE ROUTE 66
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2758
Mailing Address - Country:US
Mailing Address - Phone:732-922-4100
Mailing Address - Fax:732-210-0366
Practice Address - Street 1:3455 STATE ROUTE 66
Practice Address - Street 2:SUITE 3
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2758
Practice Address - Country:US
Practice Address - Phone:732-922-4100
Practice Address - Fax:732-210-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0090900251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health