Healthcare Provider Details

I. General information

NPI: 1043076938
Provider Name (Legal Business Name): AFUZE CONNECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 BRIAR TRAIL
VINELAND NJ
08360
US

IV. Provider business mailing address

1480 BRIAR TRAIL
VINELAND NJ
08360
US

V. Phone/Fax

Practice location:
  • Phone: 208-589-4026
  • Fax:
Mailing address:
  • Phone: 208-589-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. USIFO EDWARD ASIKHIA
Title or Position: CLINICAL DIRECTOR
Credential: BCBA-D
Phone: 208-589-4026