Provider Demographics
NPI:1780118836
Name:MCGILL CENTER FOR INDEPENDENT LIVING LLC
Entity type:Organization
Organization Name:MCGILL CENTER FOR INDEPENDENT LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:772-559-7349
Mailing Address - Street 1:920 SOUTHLAKES WAY SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-7526
Mailing Address - Country:US
Mailing Address - Phone:772-559-7349
Mailing Address - Fax:
Practice Address - Street 1:920 SOUTHLAKES WAY SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-7526
Practice Address - Country:US
Practice Address - Phone:772-559-7349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018612500Medicaid