Healthcare Provider Details

I. General information

NPI: 1699510644
Provider Name (Legal Business Name): KASEFA FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SPRING HILL DR STE G-5
WEST ORANGE NJ
07052-2412
US

IV. Provider business mailing address

5 FRANKLIN AVE STE G5
BELLEVILLE NJ
07109-3504
US

V. Phone/Fax

Practice location:
  • Phone: 973-417-8742
  • Fax: 973-751-7172
Mailing address:
  • Phone: 973-417-8742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: CHENISA SANGARE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 973-417-8742