Provider Demographics
NPI:1861851594
Name:STABLE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:STABLE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTO
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-386-0650
Mailing Address - Street 1:116 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON CITY
Practice Address - State:NJ
Practice Address - Zip Code:08016-1410
Practice Address - Country:US
Practice Address - Phone:609-386-0650
Practice Address - Fax:609-386-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000599261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0401056Medicaid
NJ0473723Medicaid
NJ0401056Medicaid