Provider Demographics
NPI:1790833242
Name:CARELINK COMMUNITY SUPPORT SERVICES OF NEW JERSEY INC
Entity Type:Organization
Organization Name:CARELINK COMMUNITY SUPPORT SERVICES OF NEW JERSEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-874-1119
Mailing Address - Street 1:106 CHESLEY DR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1759
Mailing Address - Country:US
Mailing Address - Phone:610-874-1119
Mailing Address - Fax:610-565-3802
Practice Address - Street 1:1200 LITTLE GLOUCESTER ROAD
Practice Address - Street 2:APARTMENT #1312
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-5734
Practice Address - Country:US
Practice Address - Phone:856-435-5878
Practice Address - Fax:856-435-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0053651Medicaid