Provider Demographics
NPI:1114048139
Name:FOUNDATION FOR ADULT FAMILY HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:FOUNDATION FOR ADULT FAMILY HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-7600
Mailing Address - Street 1:53 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1832
Mailing Address - Country:US
Mailing Address - Phone:973-773-7600
Mailing Address - Fax:973-773-7011
Practice Address - Street 1:53 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1832
Practice Address - Country:US
Practice Address - Phone:973-773-7600
Practice Address - Fax:973-773-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10113-01-105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9061908Medicaid