Provider Demographics
NPI:1124535158
Name:CARE SUPPORT SERVICES
Entity Type:Organization
Organization Name:CARE SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SC SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGBOYEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-715-3154
Mailing Address - Street 1:460 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-5158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5158
Practice Address - Country:US
Practice Address - Phone:773-715-3154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty