Healthcare Provider Details

I. General information

NPI: 1104730068
Provider Name (Legal Business Name): COMMUNITY CARE PROVIDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

F6 BASHFORD AVE
UNION NJ
07083-5615
US

IV. Provider business mailing address

F6 BASHFORD AVE
UNION NJ
07083-5615
US

V. Phone/Fax

Practice location:
  • Phone: 908-495-6998
  • Fax:
Mailing address:
  • Phone: 908-495-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNY MARTINEZ-PAYANO
Title or Position: OWNER
Credential: MSN, RN CMGT-BC
Phone: 908-495-6998