NPIMap

Center for Family Support, New Jersey, Inc.

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Port Monmouth, NJ

NPI 1043744089 · NPPES record last updated Apr 17, 2017

Key facts

NPI
1043744089
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
License
GH1139 (NJ)
Legal business name
CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.
Practice address
30 Collins Ave
Port Monmouth, NJ 07758-1435
Phone
(732) 471-8937
Fax
(732) 471-8957
NPI assigned
Apr 17, 2017
Organization subpart
No

Authorized official

Name
Michael Mazzocco
Title
Assistant Executive Director
Phone
(212) 629-7939

Corporate family (same tax ID) 13

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Center for Family Support New Jersey Inc (51 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X GH1139 NJ Yes

Addresses

Primary practice location

30 Collins Ave
Port Monmouth, NJ 07758-1435

Mailing address

333 7TH Ave FL 9
New York, NY 10001-5827
Phone (212) 629-7939

Other identifiers

IdentifierTypeStateIssuer
0471224MedicaidNJ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 17, 2017.

{
    "created_epoch": "1492387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492387200000",
    "number": "1043744089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 7TH AVE FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100015827",
            "telephone_number": "212-629-7939",
            "fax_number": "212-239-2211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 COLLINS AVE",
            "city": "PORT MONMOUTH",
            "state": "NJ",
            "postal_code": "077581435",
            "telephone_number": "732-471-8937",
            "fax_number": "732-471-8957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR FAMILY SUPPORT, NEW JERSEY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-17",
        "last_updated": "2017-04-17",
        "status": "A",
        "authorized_official_last_name": "MAZZOCCO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ASSISTANT EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "212-629-7939"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": "GH1139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0471224",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Monmouth, NJ

All providers in Port Monmouth, NJ · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey

Sources for this page

Verify at the official NPI Registry.