Provider Demographics
NPI:1558407528
Name:CARING FAMILY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:CARING FAMILY COMMUNITY SERVICES
Other - Org Name:CARING FAMILY MENTORS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MSN,MBA
Authorized Official - Phone:732-780-2799
Mailing Address - Street 1:1021 W COMMODORE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5372
Mailing Address - Country:US
Mailing Address - Phone:732-780-2799
Mailing Address - Fax:732-780-2899
Practice Address - Street 1:1021 W COMMODORE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5372
Practice Address - Country:US
Practice Address - Phone:732-780-2799
Practice Address - Fax:732-780-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X, 103K00000X, 104100000X
NJ1272517251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0057151Medicaid
NJ0382485Medicaid
NJ0019895Medicaid