Provider Demographics
NPI:1891394904
Name:FAVE SUPPORT SERVICES NJ INC
Entity Type:Organization
Organization Name:FAVE SUPPORT SERVICES NJ INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLALEKAN
Authorized Official - Middle Name:OYEYEMI
Authorized Official - Last Name:OSINKOLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-370-0793
Mailing Address - Street 1:4705 CREEKSIDE CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6935
Mailing Address - Country:US
Mailing Address - Phone:410-370-0793
Mailing Address - Fax:
Practice Address - Street 1:4705 CREEKSIDE CIR APT 304
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6935
Practice Address - Country:US
Practice Address - Phone:410-370-0793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7896540Medicaid