Provider Demographics
NPI:1972862563
Name:FAMILY CONNECTIONS, INC.
Entity Type:Organization
Organization Name:FAMILY CONNECTIONS, INC.
Other - Org Name:FAMILY SERVICE & CHILD GUIDANCE CENTER OF THE ORANGES, MAPLEWOOD & M
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:HRYSHKO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ACS
Authorized Official - Phone:973-323-3439
Mailing Address - Street 1:7 GLENWOOD AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1041
Mailing Address - Country:US
Mailing Address - Phone:973-675-3817
Mailing Address - Fax:973-266-1041
Practice Address - Street 1:395 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3205
Practice Address - Country:US
Practice Address - Phone:973-675-3817
Practice Address - Fax:973-673-5782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000318251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0144169Medicaid