National Provider Identifier Database

INDEPENDENT GROUP HOME LIVING
Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.


Contact Information

INDEPENDENT GROUP HOME LIVING
651 LONGWOOD RD.
MIDDLE ISLAND, NY11954
Phone: 631-878-8900
Fax: 631-878-8201
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X
Nursing Facility/Intermediate Care Facility 313M00000X

* Indicates primary specialty

NPI Profile & details for INDEPENDENT GROUP HOME LIVING

NPI Number 1538332093
Legal business name
LBN
INDEPENDENT GROUP HOME LIVING
Authorized official WALTER STOCKTON - (C.E.O.)
Entity Organization
Organization subpart No
Enumeration date 04/07/2008
Last updated 04/07/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • NY Medicaid: 00883885

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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