Provider Demographics
NPI:1700108800
Name:CENTER FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:CENTER FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YOMI
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-841-4776
Mailing Address - Street 1:2539 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2917
Mailing Address - Country:US
Mailing Address - Phone:510-841-4776
Mailing Address - Fax:510-841-6168
Practice Address - Street 1:2539 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2917
Practice Address - Country:US
Practice Address - Phone:510-841-4776
Practice Address - Fax:510-841-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies