| Self Initiated Living Options Inc | |
|
3253 Route 112 Bldg 10 Medford NY 11763-1411 | |
| (631) 880-7929 | |
| (631) 946-6377 |
| Full Name | Self Initiated Living Options Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3253 Route 112 Bldg 10, Medford, New York |
| Authorized Official Name and Position | Joseph Delgado (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6318807929 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self Initiated Living Options Inc 3253 Route 112 Bldg 10 Medford NY 11763-1411 Ph: (631) 880-7929 | Self Initiated Living Options Inc 3253 Route 112 Bldg 10 Medford NY 11763-1411 Ph: (631) 880-7929 |
| NPI Number | 1215501424 |
|---|---|
| Provider Enumeration Date | 05/13/2021 |
| Last Update Date | 08/24/2021 |
| Certification Date | 08/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215501424 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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