Provider Demographics
NPI:1043981442
Name:PERSONALIZED INDEPENDENT LIVING OPPORTUNITIES AND TRAINING SERVICES
Entity type:Organization
Organization Name:PERSONALIZED INDEPENDENT LIVING OPPORTUNITIES AND TRAINING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-809-0600
Mailing Address - Street 1:289 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2619
Mailing Address - Country:US
Mailing Address - Phone:856-697-9197
Mailing Address - Fax:
Practice Address - Street 1:283 JACKSON ROAD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-0800
Practice Address - Country:US
Practice Address - Phone:856-697-9197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities