Healthcare Provider Details

I. General information

NPI: 1033639141
Provider Name (Legal Business Name): COMMUNITY ACCESS UNLIMITD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E FRONT ST APT 4F
PLAINFIELD NJ
07060-1241
US

IV. Provider business mailing address

80 W GRAND ST
ELIZABETH NJ
07202-1471
US

V. Phone/Fax

Practice location:
  • Phone: 908-354-3040
  • Fax:
Mailing address:
  • Phone: 908-354-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0374725
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: SIDNEY BLANCHARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 908-354-3040