1942548813 NPI number — FAMCARE, INC

Table of content: (NPI 1942548813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942548813 NPI number — FAMCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMCARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942548813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLASSBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08028-1639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-881-6117
Provider Business Mailing Address Fax Number:
856-863-2816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 CHESTNUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08302-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-451-3361
Provider Business Practice Location Address Fax Number:
856-453-0056
Provider Enumeration Date:
01/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CANNADY
Authorized Official First Name:
SABRINA
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CONSULTANT
Authorized Official Telephone Number:
856-467-9344

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0017205 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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