National Provider Identifier Database

CENTER FOR INDEPENDENT LIVING OF CENTRAL PA
Voluntary or Charitable


Contact Information

CENTER FOR INDEPENDENT LIVING OF CENTRAL PA
207 HOUSE AVE
SUITE 107
CAMP HILL, PA17011-2308
Phone: 717-731-1900
Fax:
Website:
Specialty Taxonomy Code
* Voluntary or Charitable 251V00000X

* Indicates primary specialty

NPI Profile & details for CENTER FOR INDEPENDENT LIVING OF CENTRAL PA

NPI Number 1407995137
Legal business name
LBN
CENTER FOR INDEPENDENT LIVING OF CENTRAL PA
Authorized official THEOTIS BRADDY - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 02/06/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • PA Medicaid: 100003963-0005
  • PA Medicaid: 100003963-0008
  • PA Medicaid: 100003963-0010
  • PA Medicaid: 100003963-0012

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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