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General NPI Number Information
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NPI Number | 1467664540
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE INDEPENDENT LIVING CORP
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31 MAIN ROAD SUITE 9
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-369-6080
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Fax | 631-369-6085
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Provider Business Mailing Address
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Address Line | 31 MAIN ROAD SUITE 9
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-369-6080
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Fax | 631-369-6085
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Authorized Official
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Title or Position | OWNER
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Name | MS. HELENE KORBIN
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Credential | J.D., L.LM
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Telephone | 631-369-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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