Independent Group Home Living
NPI #1710150271 in Center Moriches, New York
Provider Information
- NPI Number
- 1710150271
- Entity Type
- Organization
- Organization Name
- Independent Group Home Living
- Primary Specialty
- Intermediate Care Facility, Intellectual Disabilities
- Enumeration Date
- Apr 7, 2008
- Last Updated
- Apr 7, 2008
Practice Location
- Address
- 21 MONTAUK HIGHWAY
- City
- Center Moriches
- State
- New York
- ZIP Code
- 11934
- Phone
- (631) 878-8900
Authorized Official
- Name
- MR. WALTER W. STOCKTON
- Title
- CHIEF EXECUTIVE OFFICER
- Phone
- (631) 878-8900
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nursing Facility/Intermediate Care Facility |
| Intermediate Care Facility, Intellectual Disabilities |
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