Provider Demographics
NPI:1063893634
Name:PERSONALIZED INDEPENDENT LIVING OPPORUNTITIES & TRAINING SERVICES
Entity type:Organization
Organization Name:PERSONALIZED INDEPENDENT LIVING OPPORUNTITIES & TRAINING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-673-9197
Mailing Address - Street 1:289 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2619
Mailing Address - Country:US
Mailing Address - Phone:856-809-0600
Mailing Address - Fax:856-809-0500
Practice Address - Street 1:6638 DELILAH RD STE C-D
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5659
Practice Address - Country:US
Practice Address - Phone:856-809-0600
Practice Address - Fax:856-809-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services