Provider Demographics
NPI:1588097000
Name:TOTAL INDEPENDENT COMMUNITY INCLUSION OF NJ
Entity type:Organization
Organization Name:TOTAL INDEPENDENT COMMUNITY INCLUSION OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:IHUOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-393-1256
Mailing Address - Street 1:24 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2521
Mailing Address - Country:US
Mailing Address - Phone:973-393-1256
Mailing Address - Fax:
Practice Address - Street 1:24 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2521
Practice Address - Country:US
Practice Address - Phone:973-393-1256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care