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General NPI Number Information
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NPI Number | 1942696612
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Entity Type | Organization
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Legal Business Name | INDEPENDENT SECURE LIVING, INC.
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 1615 S CONGRESS AVE SUITE 103
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6300
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Country | US
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Telephone | 561-900-6327
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Fax | 866-618-6094
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Provider Business Mailing Address
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Address Line | 7431 W ATLANTIC AVE STE 34 SUITE 121
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City | DELRAY BEACH
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State | FL
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Zip | 33446-3505
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Country | US
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Telephone | 561-900-3627
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Fax | 866-618-6094
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. CRAIG M. BASS
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Credential |
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Telephone | 401-318-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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