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General NPI Number Information
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NPI Number | 1225558331
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Entity Type | Organization
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Legal Business Name | COMMUNITY ACCESS UNLIMITD INC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 1250 N BROAD ST APT A9
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City | HILLSIDE
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State | NJ
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Zip | 07205-2485
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Country | US
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Telephone | 908-354-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 80 W GRAND ST
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City | ELIZABETH
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State | NJ
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Zip | 07202-1471
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Country | US
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Telephone | 908-354-3040
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SIDNEY BLANCHARD
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Credential |
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Telephone | 908-354-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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