Healthcare Provider Details

I. General information

NPI: 1023875309
Provider Name (Legal Business Name): CARECONNECT SUPPORTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 LINCOLN PL APT K
NORTH BRUNSWICK NJ
08902-4054
US

IV. Provider business mailing address

502 DILLION CT
NORTH BRUNSWICK NJ
08902-5510
US

V. Phone/Fax

Practice location:
  • Phone: 908-257-1057
  • Fax:
Mailing address:
  • Phone: 908-257-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: FATMATA BARRIE
Title or Position: CO-OWNER
Credential:
Phone: 908-257-1057