INDEPENDENT GROUP HOME LIVING


Address: 114 N Phillips Ave, Speonk, NY 11972
Phone: 6318788900

INDEPENDENT GROUP HOME LIVING (NPI# 1801069372) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1801069372
Entity Type Organization
Organization Name INDEPENDENT GROUP HOME LIVING
Practice Address 114 N Phillips Ave
Speonk
NY 11972
Mailing Address 221 N Sunrise Service Rd
Manorville
NY 11949-9604
Practice Telephone 6318788900
Practice Fax Number 6318788201
Mailing Telephone 6318788900
Mailing Fax Number 6318788201
Enumeration Date 2008-04-07
Last Update Date 2008-04-07
Authorized Official Name MR. WALTER W STOCKTON (C.E.O.)
Authorized Official Telephone 6318788900
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 313M00000X Nursing Facility/Intermediate Care Facility Nursing & Custodial Care Facilities
Y 315P00000X Intermediate Care Facility, Mentally Retarded Nursing & Custodial Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
NY 00945455 05

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1174796635 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 65 Pine St, East Moriches, NY 11940 2008-04-07
1356514814 Independent Group Home Living Nursing Facility/Intermediate Care Facility 120 Frowein Rd, East Moriches, NY 11940 2008-04-07
1275706731 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 125 Sebonic Rd, South Hampton, NY 11955 2008-04-07
1457524910 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 133 Shore Rd W, Mount Sinai, NY 11766-1237 2008-04-07
1629241187 Independent Group Home Living Nursing Facility/Intermediate Care Facility 44 Woodland Ave, Manorville, NY 11949-9604 2008-04-07
1366615825 Independent Group Home Living Nursing Facility/Intermediate Care Facility 864 Pleasure Dr, Flanders, NY 11901 2008-04-07
1629241195 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 288 Chapman Blvd, Manorville, NY 11949-3125 2008-04-07
1538332093 Independent Group Home Living Nursing Facility/Intermediate Care Facility 651 Longwood Rd., Middle Island, NY 11954 2008-04-07
1801069364 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 135 Old Country Rd, East Quogue, NY 11942 2008-04-07
1710150271 Independent Group Home Living Nursing Facility/Intermediate Care Facility 21 Montauk Highway, Center Moriches, NY 11934 2008-04-07

Other Data Sources

Entity Type Entity Name Entity Address
New York State Corporations INDEPENDENT GROUP HOME LIVING PROGRAM FOUNDATION 221 North Sunrise Service Rd., Manorville, New York 11949
New York State Corporations INDEPENDENT GROUP HOME LIVING PROGRAM, INC. 221 North Sunrise Service Rd., Manorville, Ny 11949

Office Location

Street Address 114 N PHILLIPS AVE
City SPEONK
State NY
Zip Code 11972

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1528355815 Joann Piche Counselor 3 Laura Ct, Speonk, NY 11972 2011-07-07
1962692244 Janine Marie Bryant Registered Nurse 4 5th Avenue, Speonk, NY 11972 2007-08-01
1821196585 Jennifer Anne Fay Psychologist 170 Montauk Highway, Speonk, NY 11972 2006-09-20
1255393195 Island Home Care Agency, Inc Home Infusion 193 Montauk Hwy, Speonk, NY 11972 2006-04-05
1679867998 Dr. Diane Brooks, Psyd, PC Psychologist 170 Montauk Hway, Speonk, NY 11972 2011-06-03
1538458385 Alexis Gersten Dentist 195 Montauk Highway, Speonk, NY 11972 2011-04-01
1235260233 Kelly C Palomo Physical Therapist 295 Montauk Highway, Speonk, NY 11972 2007-03-08
1598814774 Diane Joyce Brooks Psychologist 170 Montauk Hway, Speonk, NY 11972-0227 2007-01-09
1477623171 James C Pierce Chiropractor 295 Montauk Highway, Speonk, NY 11972-0244 2006-11-09
1346560513 James C Pierce Dc PC Chiropractor 295 Montauk Highway, Speonk, NY 11972-0244 2010-06-10
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Taxonomy Information

Taxonomy Code 315P00000X
Grouping Nursing & Custodial Care Facilities
Classification Intermediate Care Facility, Mentally Retarded

Taxonomy Definition

(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.
Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c).

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1336762665 Schuyler County Chapter, Nysarc, Inc. Intermediate Care Facility, Mentally Retarded 260 W 8th St, Elmira Heights, NY 14903-1502 2020-05-21
1518580851 Schuyler County Chapter, Nysarc, Inc. Intermediate Care Facility, Mentally Retarded 525 Liberty St, Elmira, NY 14904-1517 2020-05-21
1386276541 United Cerebral Palsy of Nyc Inc Intermediate Care Facility, Mentally Retarded 1841-1845 Lacombe Ave, Bronx, NY 10472 2020-02-06
1003447012 State of New York Intermediate Care Facility, Mentally Retarded 8045 Winchester Blvd Bldg 08, Queens Village, NY 11427-2194 2020-01-29
1427696061 Elderberry Icf Intermediate Care Facility, Mentally Retarded 15 Poem Place, Monticello, NY 12701 2019-12-13
1538666052 Upstate Cerebral Palsy, Inc. Intermediate Care Facility, Mentally Retarded 95 Seymour Lane, Westmoreland, NY 13490 2018-04-11
1457857716 Nysarc, Inc. Cattaraugus-niagara County Chapter Intermediate Care Facility, Mentally Retarded 6821 Saunders Settlement Rd, Sanborn, NY 14132-9440 2018-04-04
1750804951 Iri: Innovative Resources for Independence Intermediate Care Facility, Mentally Retarded 922 Rainbow Commons Ct, Melville, NY 11747 2017-07-19
1962959403 Linda Burgess Intermediate Care Facility, Mentally Retarded 35 E 8th Ave, Gloversville, NY 12078-2229 2016-09-01
1154774727 Birch Family Services, Inc. Intermediate Care Facility, Mentally Retarded 525 W 149th St, New York, NY 10031-3402 2016-07-19
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City SPEONK
Zip Code 11972

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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