Provider Demographics
NPI:1538600689
Name:SIERRA SOCIAL SERVICES
Entity type:Organization
Organization Name:SIERRA SOCIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:T
Authorized Official - Last Name:FOFANAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-423-5397
Mailing Address - Street 1:15 HILL RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4603
Mailing Address - Country:US
Mailing Address - Phone:732-423-5397
Mailing Address - Fax:
Practice Address - Street 1:15 HILL RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4603
Practice Address - Country:US
Practice Address - Phone:732-423-5397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities