Provider Demographics
NPI:1760520100
Name:COMMUNITY ACCESS UNLIMITED
Entity Type:Organization
Organization Name:COMMUNITY ACCESS UNLIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-354-3040
Mailing Address - Street 1:80 WEST GRAND STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1447
Mailing Address - Country:US
Mailing Address - Phone:908-354-3040
Mailing Address - Fax:908-354-2665
Practice Address - Street 1:640 SUMMER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3645
Practice Address - Country:US
Practice Address - Phone:908-354-3040
Practice Address - Fax:908-354-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8715408Medicaid