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General NPI Number Information
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NPI Number | 1124690623
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS COMMUNITY SERVICES
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 35B WALL ST
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City | OXFORD
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State | NJ
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Zip | 07863-6618
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Country | US
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Telephone | 973-436-4704
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Fax | 973-436-4704
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Provider Business Mailing Address
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Address Line | 209 PASSAIC AVE
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1960
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Country | US
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Telephone | 973-436-4704
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Fax | 973-436-4704
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AMA J BAFFOE
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Credential |
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Telephone | 973-392-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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