Provider Demographics
NPI:1326265349
Name:CIRCLE OF CARE FOR FAMILIES AND CHILDREN OF PASSAIC COUNTY
Entity Type:Organization
Organization Name:CIRCLE OF CARE FOR FAMILIES AND CHILDREN OF PASSAIC COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-942-4588
Mailing Address - Street 1:601 HAMBURG TURNPIKE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-942-4588
Mailing Address - Fax:973-942-4688
Practice Address - Street 1:601 HAMBURG TURNPIKE, SUITE 100
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-942-4588
Practice Address - Fax:973-942-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0055743Medicaid