Provider Demographics
NPI:1124690623
Name:FOUR CORNERS COMMUNITY SERVICES
Entity type:Organization
Organization Name:FOUR CORNERS COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAFFOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-392-0430
Mailing Address - Street 1:209 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1960
Mailing Address - Country:US
Mailing Address - Phone:973-436-4704
Mailing Address - Fax:973-436-4704
Practice Address - Street 1:35B WALL ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NJ
Practice Address - Zip Code:07863-6618
Practice Address - Country:US
Practice Address - Phone:973-436-4704
Practice Address - Fax:973-436-4704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR CORNERS COMMUNITY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services