INDEPENDENT GROUP HOME LIVING


Address: 125 Sebonic Rd, South Hampton, NY 11955
Phone: 6318788900

INDEPENDENT GROUP HOME LIVING (NPI# 1275706731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1275706731
Entity Type Organization
Organization Name INDEPENDENT GROUP HOME LIVING
Practice Address 125 Sebonic Rd
South Hampton
NY 11955
Mailing Address 221 N Sunrise Service Rd
Manorville
NY 11949-9604
Practice Telephone 6318788900
Practice Fax Number 6318788201
Mailing Telephone 6318788900
Mailing Fax Number 6318788201
Enumeration Date 2008-04-07
Last Update Date 2008-04-07
Authorized Official Name MR. WALTER W STOCKTON (C.E.O.)
Authorized Official Telephone 6318788900
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 315P00000X Intermediate Care Facility, Mentally Retarded Nursing & Custodial Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
NY 01060526 05

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1174796635 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 65 Pine St, East Moriches, NY 11940 2008-04-07
1356514814 Independent Group Home Living Nursing Facility/Intermediate Care Facility 120 Frowein Rd, East Moriches, NY 11940 2008-04-07
1457524910 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 133 Shore Rd W, Mount Sinai, NY 11766-1237 2008-04-07
1629241187 Independent Group Home Living Nursing Facility/Intermediate Care Facility 44 Woodland Ave, Manorville, NY 11949-9604 2008-04-07
1366615825 Independent Group Home Living Nursing Facility/Intermediate Care Facility 864 Pleasure Dr, Flanders, NY 11901 2008-04-07
1629241195 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 288 Chapman Blvd, Manorville, NY 11949-3125 2008-04-07
1538332093 Independent Group Home Living Nursing Facility/Intermediate Care Facility 651 Longwood Rd., Middle Island, NY 11954 2008-04-07
1801069372 Independent Group Home Living Nursing Facility/Intermediate Care Facility 114 N Phillips Ave, Speonk, NY 11972 2008-04-07
1801069364 Independent Group Home Living Intermediate Care Facility, Mentally Retarded 135 Old Country Rd, East Quogue, NY 11942 2008-04-07
1710150271 Independent Group Home Living Nursing Facility/Intermediate Care Facility 21 Montauk Highway, Center Moriches, NY 11934 2008-04-07

Other Data Sources

Entity Type Entity Name Entity Address
New York State Corporations INDEPENDENT GROUP HOME LIVING PROGRAM FOUNDATION 221 North Sunrise Service Rd., Manorville, New York 11949
New York State Corporations INDEPENDENT GROUP HOME LIVING PROGRAM, INC. 221 North Sunrise Service Rd., Manorville, Ny 11949

Office Location

Street Address 125 SEBONIC RD
City SOUTH HAMPTON
State NY
Zip Code 11955

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1639488810 Donna Susan Moeller Registered Nurse 630 Moriches Middle Island Road, Moriches, NY 11955 2010-10-05
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Taxonomy Information

Taxonomy Code 315P00000X
Grouping Nursing & Custodial Care Facilities
Classification Intermediate Care Facility, Mentally Retarded

Taxonomy Definition

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c).

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1336762665 Schuyler County Chapter, Nysarc, Inc. Intermediate Care Facility, Mentally Retarded 260 W 8th St, Elmira Heights, NY 14903-1502 2020-05-21
1518580851 Schuyler County Chapter, Nysarc, Inc. Intermediate Care Facility, Mentally Retarded 525 Liberty St, Elmira, NY 14904-1517 2020-05-21
1386276541 United Cerebral Palsy of Nyc Inc Intermediate Care Facility, Mentally Retarded 1841-1845 Lacombe Ave, Bronx, NY 10472 2020-02-06
1003447012 State of New York Intermediate Care Facility, Mentally Retarded 8045 Winchester Blvd Bldg 08, Queens Village, NY 11427-2194 2020-01-29
1427696061 Elderberry Icf Intermediate Care Facility, Mentally Retarded 15 Poem Place, Monticello, NY 12701 2019-12-13
1538666052 Upstate Cerebral Palsy, Inc. Intermediate Care Facility, Mentally Retarded 95 Seymour Lane, Westmoreland, NY 13490 2018-04-11
1457857716 Nysarc, Inc. Cattaraugus-niagara County Chapter Intermediate Care Facility, Mentally Retarded 6821 Saunders Settlement Rd, Sanborn, NY 14132-9440 2018-04-04
1750804951 Iri: Innovative Resources for Independence Intermediate Care Facility, Mentally Retarded 922 Rainbow Commons Ct, Melville, NY 11747 2017-07-19
1962959403 Linda Burgess Intermediate Care Facility, Mentally Retarded 35 E 8th Ave, Gloversville, NY 12078-2229 2016-09-01
1154774727 Birch Family Services, Inc. Intermediate Care Facility, Mentally Retarded 525 W 149th St, New York, NY 10031-3402 2016-07-19
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Competitor

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City SOUTH HAMPTON
Zip Code 11955

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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