Basic Information
| Provider Information | |||||||||
| NPI: | 1043318793 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMCARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080281639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567941235 | ||||||||
| FaxNumber: | 8568632816 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GLASSBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080281639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568819531 | ||||||||
| FaxNumber: | 8568632816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | NIXON | ||||||||
| AuthorizedOfficialFirstName: | KATHIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8567941235 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | WHNP-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0050X | 70891 | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 0017205 | 05 | NJ | MEDICAID |