Provider Demographics
NPI:1437585411
Name:FORKIDCARE, LLC
Entity type:Organization
Organization Name:FORKIDCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZZICHILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-346-3300
Mailing Address - Street 1:1304 LAUREL OAK RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4310
Mailing Address - Country:US
Mailing Address - Phone:856-346-3300
Mailing Address - Fax:856-435-4223
Practice Address - Street 1:1304 LAUREL OAK RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4310
Practice Address - Country:US
Practice Address - Phone:856-346-3300
Practice Address - Fax:856-435-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7273509Medicaid