Provider Demographics
NPI:1932785631
Name:FOUR CORNERS COMMUNITY SERVICES LLC
Entity Type:Organization
Organization Name:FOUR CORNERS COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAFFOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-436-4704
Mailing Address - Street 1:209 PASSAIC AVENUE
Mailing Address - Street 2:FL 1
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:973-436-4704
Mailing Address - Fax:973-436-4714
Practice Address - Street 1:35A WALL ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NJ
Practice Address - Zip Code:07863-6616
Practice Address - Country:US
Practice Address - Phone:973-436-4704
Practice Address - Fax:973-436-4714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUR CORNERS COMMUNITY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty