Provider Demographics
NPI:1972900777
Name:ADVOCACY FAMILY SUPPORT SERVICES.
Entity Type:Organization
Organization Name:ADVOCACY FAMILY SUPPORT SERVICES.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:NNEDINMA
Authorized Official - Last Name:SALAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS DEGREE
Authorized Official - Phone:732-762-8739
Mailing Address - Street 1:41 LA GORCE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08016
Mailing Address - Country:US
Mailing Address - Phone:732-762-8739
Mailing Address - Fax:
Practice Address - Street 1:41 LA GORCE BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2938
Practice Address - Country:US
Practice Address - Phone:732-762-8739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251B00000X
NJ103TM1800X305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1972900777Medicaid