NPIMap

Organization Active NPI

Independent Group Home Living

  • Intellectual Disabilities Intermediate Care Facility
  • Eastport, NY
National Provider Identifier
1548433006
Registry record updated Apr 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
INDEPENDENT GROUP HOME LIVING
Practice address
535 Moutauk Highway
Eastport, NY 11941
Phone
(631) 878-8900
Fax
(631) 878-8201
NPI assigned
Apr 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2008

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

Authorized official

Name
Mr. Walter W. Stockton
Title
Chief Executive Officer
Phone
(631) 878-8900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

535 Moutauk Highway
Eastport, NY 11941

Mailing address

221 N Sunrise Service Rd
Manorville, NY 11949-9604
Phone (631) 878-8900

Other identifiers 1

IdentifierTypeStateIssuer
01118776MedicaidNY

National Provider Directory

National Provider Directory
Tax ID family
Independent Group Home Living21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

535 Montauk Hwy
Eastport, NY 11941

NPI Registry JSON

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

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1548433006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 N SUNRISE SERVICE RD",
            "city": "MANORVILLE",
            "state": "NY",
            "postal_code": "119499604",
            "telephone_number": "631-878-8900",
            "fax_number": "631-878-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 MOUTAUK HIGHWAY",
            "city": "EASTPORT",
            "state": "NY",
            "postal_code": "11941",
            "telephone_number": "631-878-8900",
            "fax_number": "631-878-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT GROUP HOME LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-04-07",
        "status": "A",
        "authorized_official_last_name": "STOCKTON",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "631-878-8900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01118776",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eastport, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; 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.