Healthcare Provider Details

I. General information

NPI: 1114363033
Provider Name (Legal Business Name): COMMUNITY MILESTONES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 05/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 S FULLERTON AVE SUITE 107
MONTCLAIR NJ
07042-2632
US

IV. Provider business mailing address

PO BOX 2011
EAST ORANGE NJ
07019-2011
US

V. Phone/Fax

Practice location:
  • Phone: 973-273-4401
  • Fax: 973-273-4406
Mailing address:
  • Phone: 973-273-4401
  • Fax: 973-273-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAMON K CEASER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 973-273-4401