Provider Demographics
NPI:1427179647
Name:CENTER FOR INDEPENDENT LIVING OF NORTH CENTRAL PA
Entity type:Organization
Organization Name:CENTER FOR INDEPENDENT LIVING OF NORTH CENTRAL PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:570-327-9070
Mailing Address - Street 1:210 MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6638
Mailing Address - Country:US
Mailing Address - Phone:570-327-9070
Mailing Address - Fax:570-327-8610
Practice Address - Street 1:210 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6638
Practice Address - Country:US
Practice Address - Phone:570-327-9070
Practice Address - Fax:570-327-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA54OtherINTERMEDIATE SERV. ORG
PA55OtherVENDOR
PA59OtherATTENDANT CARE
PA51OtherHOME AND COMMUNITY HABILI