Provider Demographics
NPI:1790017051
Name:MADONA FAMILY SUPPORT INC
Entity Type:Organization
Organization Name:MADONA FAMILY SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMEKA
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:OKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN (BSN)
Authorized Official - Phone:856-728-0781
Mailing Address - Street 1:119 HARMONY CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-5635
Mailing Address - Country:US
Mailing Address - Phone:856-728-0781
Mailing Address - Fax:856-728-0781
Practice Address - Street 1:119 HARMONY CIRCLE RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-5635
Practice Address - Country:US
Practice Address - Phone:856-728-0781
Practice Address - Fax:856-728-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child