Provider Demographics
NPI:1942770623
Name:COMMUNITY SUPPORT SERVICES OF NJ
Entity Type:Organization
Organization Name:COMMUNITY SUPPORT SERVICES OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-931-8969
Mailing Address - Street 1:74 HORSENECK RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9303
Mailing Address - Country:US
Mailing Address - Phone:973-931-8969
Mailing Address - Fax:973-265-0799
Practice Address - Street 1:74 HORSENECK RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9303
Practice Address - Country:US
Practice Address - Phone:973-931-8969
Practice Address - Fax:973-265-0799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services