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General NPI Number Information
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NPI Number | 1871771048
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Entity Type | Organization
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Legal Business Name | CENTER FOR INDEPENDENT LIVING INC
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Dates
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Enumeration Date | 02/09/2008
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Last Update Date | 02/09/2008
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Provider Practice Location Address
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Address Line | 4700 BUCHANAN DR
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City | FORT PIERCE
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State | FL
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Zip | 34982-7108
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Country | US
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Telephone | 772-460-2108
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Fax | 772-466-0969
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Provider Business Mailing Address
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Address Line | 4700 BUCHANAN DR
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City | FORT PIERCE
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State | FL
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Zip | 34982-7108
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Country | US
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Telephone | 772-460-2108
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Fax | 772-466-0969
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Authorized Official
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Title or Position | ADM
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Name | DONNA JEAN IACONA
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Credential |
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Telephone | 772-460-2108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL10026
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License Number State | FL
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