Basic Information
Provider Information
NPI: 1346491230
EntityType: 2
ReplacementNPI:  
OrganizationName: INSTITUTE FOR COMMUNITY LIVING
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Mailing Information
Address1: 40 RECTOR STREET
Address2:  
City: NEW YORK
State: NY
PostalCode: 100061705
CountryCode: US
TelephoneNumber: 2123853030
FaxNumber: 2123749225
Practice Location
Address1: 161 EMERSON PLACE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 11205
CountryCode: US
TelephoneNumber: 7186361463
FaxNumber: 7186361710
Other Information
ProviderEnumerationDate: 10/09/2008
LastUpdateDate: 10/09/2008
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AuthorizedOfficialLastName: HOWARD
AuthorizedOfficialFirstName: DEWEY
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AuthorizedOfficialTitleorPosition: CHIEF FINANCIAL OFFICER
AuthorizedOfficialTelephone: 2123853030
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: CPA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
320800000X  Y Residential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness 

No ID Information.


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