MEDICARE: COMMUNITY CONNECTIONS COORDINATORS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558218669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CONNECTIONS COORDINATORS

Provider Business Mailing Address
First Line	:	100 EISENHOWER PKWY APT 357
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2859
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 EISENHOWER PKWY APT 357
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-2859
Country	:	US
Telephone Number	:	973-658-6019
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ITOHAN RITA EDOBOR-OSULA
Credential	:
Telephone Number	:	973-658-6019

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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