Organization
FIVIC SUPPORT SERVICES
Active
Other names
Four Corners Community Services
Organization subpart
No
Provider details
NPI number
Authorized official
AMA J BAFFOE (EXECUTIVE DIRECTOR)
(973) 392-0430
Entity
Organization
Contact information
Practice address
209 PASSAIC AVE, BELLEVILLE, NJ 07109-1960
(973) 392-0430
Mailing address
209 PASSAIC AVE, BELLEVILLE, NJ 07109-1960
(973) 392-0430
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1946
—
NJ
Enumeration date
11/30/2022
Last updated
11/30/2022
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