Provider Demographics
NPI:1124679360
Name:A FAMILY FUN PROGRAM LLC
Entity type:Organization
Organization Name:A FAMILY FUN PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERTHONY
Authorized Official - Middle Name:FJ
Authorized Official - Last Name:DOMINGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-860-8552
Mailing Address - Street 1:2675 FRIES MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-3336
Mailing Address - Country:US
Mailing Address - Phone:973-860-8552
Mailing Address - Fax:
Practice Address - Street 1:2675 FRIES MILL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-3336
Practice Address - Country:US
Practice Address - Phone:973-860-8552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2050XRespite Care FacilityRespite CareRespite Care Camp