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General NPI Number Information
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NPI Number | 1104730068
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE PROVIDERS
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Dates
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Enumeration Date | 09/29/2026
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | F6 BASHFORD AVE
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City | UNION
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State | NJ
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Zip | 07083-5615
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Country | US
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Telephone | 908-495-6998
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Fax |
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Provider Business Mailing Address
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Address Line | F6 BASHFORD AVE
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City | UNION
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State | NJ
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Zip | 07083-5615
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Country | US
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Telephone | 908-495-6998
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNY MARTINEZ-PAYANO
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Credential | MSN, RN CMGT-BC
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Telephone | 908-495-6998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number |
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License Number State | NULL
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