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General NPI Number Information
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NPI Number | 1932785631
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Entity Type | Organization
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Legal Business Name | FOUR CORNERS COMMUNITY SERVICES LLC
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 35A WALL ST
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City | OXFORD
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State | NJ
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Zip | 07863-6616
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Country | US
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Telephone | 973-436-4704
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Fax | 973-436-4714
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Provider Business Mailing Address
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Address Line | 209 PASSAIC AVENUE FL 1
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City | BELLEVILLE
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State | NJ
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Zip | 07109
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Country | US
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Telephone | 973-436-4704
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Fax | 973-436-4714
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. AMA J BAFFOE
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Credential |
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Telephone | 973-436-4704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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