Provider Demographics
NPI:1699060483
Name:FAMILY & COMMUNITY SERVICES OF SOMERSET COUNTY
Entity type:Organization
Organization Name:FAMILY & COMMUNITY SERVICES OF SOMERSET COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-356-1082
Mailing Address - Street 1:339 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1833
Mailing Address - Country:US
Mailing Address - Phone:732-356-1082
Mailing Address - Fax:732-356-6327
Practice Address - Street 1:339 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1833
Practice Address - Country:US
Practice Address - Phone:732-356-1082
Practice Address - Fax:732-356-6327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7620501Medicaid