Healthcare Provider Details

I. General information

NPI: 1417609215
Provider Name (Legal Business Name): ALLIANCE COMMUNITY SUPPORT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 BELVIDERE AVE
WASHINGTON NJ
07882-1417
US

IV. Provider business mailing address

126 BELVIDERE AVE
WASHINGTON NJ
07882-1417
US

V. Phone/Fax

Practice location:
  • Phone: 908-343-6765
  • Fax:
Mailing address:
  • Phone: 908-343-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON HUMANICK
Title or Position: MANAGING MEMBER
Credential:
Phone: 908-343-6765