Provider Demographics
NPI:1962874057
Name:EASTERN SHORE CENTER FOR INDEPENDENT LIVING, INC
Entity type:Organization
Organization Name:EASTERN SHORE CENTER FOR INDEPENDENT LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-0100
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:BELLE HAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:23306
Mailing Address - Country:US
Mailing Address - Phone:757-414-0100
Mailing Address - Fax:757-414-0205
Practice Address - Street 1:36282 LANKFORD HIGHWAY
Practice Address - Street 2:SUITE 13-D
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-414-0100
Practice Address - Fax:757-414-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management