Provider Demographics
NPI:1851639728
Name:FAMCARE, INC
Entity Type:Organization
Organization Name:FAMCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANNADY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:856-467-9344
Mailing Address - Street 1:711 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1639
Mailing Address - Country:US
Mailing Address - Phone:856-881-6117
Mailing Address - Fax:856-863-2816
Practice Address - Street 1:370 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2655
Practice Address - Country:US
Practice Address - Phone:856-678-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017205Medicaid