Provider Demographics
NPI:1043914682
Name:COMMUNITY ACCESS UNLIMITD INC
Entity Type:Organization
Organization Name:COMMUNITY ACCESS UNLIMITD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AED OF EHR SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAKIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-354-3040
Mailing Address - Street 1:80 W GRAND ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1471
Mailing Address - Country:US
Mailing Address - Phone:908-354-3040
Mailing Address - Fax:
Practice Address - Street 1:193 TERRILL RD STE 3
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1058
Practice Address - Country:US
Practice Address - Phone:908-354-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0374725Medicaid