Provider Demographics
NPI:1356087456
Name:JERSEY FAMILY CARE
Entity Type:Organization
Organization Name:JERSEY FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONZUELO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:551-274-3876
Mailing Address - Street 1:63 HILL ST APT 5M
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7608
Mailing Address - Country:US
Mailing Address - Phone:551-274-3876
Mailing Address - Fax:
Practice Address - Street 1:63 HILL ST APT 5M
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7608
Practice Address - Country:US
Practice Address - Phone:551-274-3876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1164058442Medicaid
NJ1093180911Medicaid