Provider Demographics
NPI:1356050348
Name:FAMILY SUPPORT SOCIAL SERVICES, LLC
Entity type:Organization
Organization Name:FAMILY SUPPORT SOCIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BIBIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHOLONU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-404-2396
Mailing Address - Street 1:20 MULLEN DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1660
Mailing Address - Country:US
Mailing Address - Phone:856-404-2396
Mailing Address - Fax:
Practice Address - Street 1:20 MULLEN DR
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1660
Practice Address - Country:US
Practice Address - Phone:856-404-2396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SUPPORT SOCIAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450864266OtherBUSINESS LICENSE