# FIVIC SUPPORT SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Four Corners Community Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164132148
- **Authorized official:** AMA J BAFFOE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (973) 392-0430

## Contact information

- **Practice address:** 209 PASSAIC AVE, BELLEVILLE, NJ 07109-1960
- **Practice address phone:** (973) 392-0430
- **Mailing address:** 209 PASSAIC AVE, BELLEVILLE, NJ 07109-1960
- **Mailing address phone:** (973) 392-0430

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 261QA0600X | Adult Day Care Clinic/Center | — | NULL | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 11/30/2022
- **Last updated:** 11/30/2022