Provider Demographics
NPI:1043739634
Name:FAMILY CARE CONNECTIONS, LLC
Entity Type:Organization
Organization Name:FAMILY CARE CONNECTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:BETNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-579-7303
Mailing Address - Street 1:44 COOPER ST STE 6
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4653
Mailing Address - Country:US
Mailing Address - Phone:856-579-7303
Mailing Address - Fax:856-579-7298
Practice Address - Street 1:44 COOPER ST STE 6
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4653
Practice Address - Country:US
Practice Address - Phone:856-579-7303
Practice Address - Fax:856-579-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101979251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0474771Medicaid