Center for Independent Living of Central PA

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

CENTER FOR INDEPENDENT LIVING OF CENTRAL PA

Practice address

207 House Ave
Suite 107
Camp Hill, PA 17011-2308

Phone

(717) 731-1900

NPI assigned

Feb 6, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theotis W. Braddy

Title

Executive Director

Phone

(717) 731-1900

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407995137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 HOUSE AVE",
            "address_2": "SUITE 107",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112308",
            "telephone_number": "717-731-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 HOUSE AVE",
            "address_2": "SUITE 107",
            "city": "CAMP HILL",
            "state": "PA",
            "postal_code": "170112308",
            "telephone_number": "717-731-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR INDEPENDENT LIVING OF CENTRAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRADDY",
        "authorized_official_first_name": "THEOTIS",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "717-731-1900"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100003963-0010",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100003963-0005",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100003963-0012",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100003963-0008",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Voluntary or Charitable Agency in Camp Hill, PA
• Providers in Camp Hill, PA by specialty
• Voluntary or Charitable Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.