Provider Demographics
NPI:1760924823
Name:GOOD NEIGHBOR SUPPORT SERVICES
Entity Type:Organization
Organization Name:GOOD NEIGHBOR SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORT CORDINATOR SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGBOYEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:718-710-2234
Mailing Address - Street 1:326 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-5139
Mailing Address - Country:US
Mailing Address - Phone:718-710-2234
Mailing Address - Fax:732-827-5932
Practice Address - Street 1:326 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-5139
Practice Address - Country:US
Practice Address - Phone:718-710-2234
Practice Address - Fax:732-827-5932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0506532Medicaid