Provider Demographics
NPI:1871634055
Name:COMPREHENSIVE CARE SERVICES INC
Entity Type:Organization
Organization Name:COMPREHENSIVE CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:732-287-4044
Mailing Address - Street 1:4 ETHEL ROAD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:732-287-4044
Mailing Address - Fax:732-287-0211
Practice Address - Street 1:4 ETHEL ROAD
Practice Address - Street 2:SUITE 404
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-287-4044
Practice Address - Fax:732-287-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05223100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0057789Medicaid
NJ0060364OtherWORK FIRST
NJ089774Medicare ID - Type Unspecified