| Self Initiated Living Options Inc | |
|
3245 Route 112 Ste 1 Medford NY 11763-1441 | |
| (631) 880-7929 | |
| Not Available |
| Full Name | Self Initiated Living Options Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3245 Route 112 Ste 1, Medford, New York |
| Authorized Official Name and Position | Laurie Delgado (AM) |
| 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) 880-7329 | Self Initiated Living Options Inc 3245 Route 112 Ste 1 Medford NY 11763-1441 Ph: (631) 880-7929 |
| NPI Number | 1558139709 |
|---|---|
| Provider Enumeration Date | 12/18/2023 |
| Last Update Date | 12/18/2023 |
| Certification Date | 12/18/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558139709 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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