Provider Demographics
NPI:1043318793
Name:FAMCARE, INC.
Entity Type:Organization
Organization Name:FAMCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP-BC
Authorized Official - Phone:856-794-1235
Mailing Address - Street 1:711 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1639
Mailing Address - Country:US
Mailing Address - Phone:856-794-1235
Mailing Address - Fax:856-863-2816
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1639
Practice Address - Country:US
Practice Address - Phone:856-881-9531
Practice Address - Fax:856-863-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70891261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017205Medicaid