Provider Demographics
NPI:1982564597
Name:FOUR CORNERS COMMUNITY SERVICES LLC
Entity type:Organization
Organization Name:FOUR CORNERS COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAFFOE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-210-6066
Mailing Address - Street 1:209 PASSAIC AVE FL 1
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:973-436-4714
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEN GARDNER
Practice Address - State:NJ
Practice Address - Zip Code:08826-3616
Practice Address - Country:US
Practice Address - Phone:973-436-4704
Practice Address - Fax:973-436-4714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR CORNERS COMMUNITY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-15
Last Update Date:2025-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No251X00000XAgenciesSupports Brokerage
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities