MEDICARE: PERSONALIZED INDEPENDENT LIVING OPPORUNTITIES & TRAINING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1063893634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONALIZED INDEPENDENT LIVING OPPORUNTITIES & TRAINING SERVICES

Provider Business Mailing Address
First Line	:	289 JACKSON RD
Second Line	:
City	:	BERLIN
State	:	NJ
Zip	:	08009-2619
Country	:	US
Telephone Number	:	856-809-0600
Fax Number	:	856-809-0500

Provider Business Practice Location Address
First Line	:	6638 DELILAH RD STE C-D
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-5659
Country	:	US
Telephone Number	:	856-809-0600
Fax Number	:	856-809-0500

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ALLEN J. SAMUELS
Credential	:
Telephone Number	:	856-673-9197

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	02/01/2023

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