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INDEPENDENT SERVICE PROVIDER, LLC 1740959535

Overview
Name: INDEPENDENT SERVICE PROVIDER, LLC Specialty: Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Type of Practice: Organization Provider/Org: Medical School: Graduation year from medical school: Affiliation:
Specialties
Practice Type: Residential Treatment Facilities Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities Specialization: . Definition of Specialty: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
License & NPI
License #(s): , , , , License State(s): , , , ,
Addresses
Practice Location: INDEPENDENT SERVICE PROVIDER, LLC,3544 N PROGRESS AVE STE 205,HARRISBURG,PA,171109638,US Mailing Address: INDEPENDENT SERVICE PROVIDER, LLC,3544 N PROGRESS AVE STE 205,HARRISBURG,PA,171109638,US
Contact #
Practice location phone #: 7178827892 Practice location fax #: Mailing address Phone #: 7178827892 Mailing Address fax #: Authorized official Name/Telephone #:TILAK, NIROULA, DIRECTOR 7178827892
Misc
Date NPI was obtained: 09/07/2021 Last data data was updated: 09/07/2021 Insurances:

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