Provider Demographics
NPI:1407736499
Name:SUREBRIDGE COMMUNITY SUPPORTS
Entity type:Organization
Organization Name:SUREBRIDGE COMMUNITY SUPPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIDIEBERE
Authorized Official - Middle Name:
Authorized Official - Last Name:AZUBUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-347-5040
Mailing Address - Street 1:335 GEORGE ST STE 4
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-4080
Mailing Address - Country:US
Mailing Address - Phone:201-347-5040
Mailing Address - Fax:732-960-1956
Practice Address - Street 1:2003 HOUSELL CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-2615
Practice Address - Country:US
Practice Address - Phone:201-347-5040
Practice Address - Fax:732-960-1956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health