Provider Demographics
NPI:1659019594
Name:FAMILY EXTENDED CARE SERVICES
Entity Type:Organization
Organization Name:FAMILY EXTENDED CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DASIA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-938-2767
Mailing Address - Street 1:247 HOFFMAN BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-5011
Mailing Address - Country:US
Mailing Address - Phone:973-938-2767
Mailing Address - Fax:
Practice Address - Street 1:247 HOFFMAN BLVD # 1
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-5011
Practice Address - Country:US
Practice Address - Phone:973-938-2767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities