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Advoserv of New Jersey, Inc.

Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Pilesgrove, NJ

NPI 1104206192 · NPPES record last updated Mar 11, 2016

Key facts

NPI
1104206192
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
License
GH2165 (NJ)
Legal business name
ADVOSERV OF NEW JERSEY, INC.
Practice address
230 Marlton Rd
Pilesgrove, NJ 08098-2718
Phone
(856) 241-3320
Fax
(856) 241-3321
NPI assigned
Jun 4, 2015
Organization subpart
Yes
Parent organization (as reported)
ADVOSERV OF NEW JERSEY, INC.

Authorized official

Name
Darren Blough, M.S.W., BCABA
Title
State Director
Phone
(856) 241-3320

Corporate family (same tax ID) 20

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Advoserv of New Jersey Inc (92 organizations share this tax ID)
Part of
Advoserv of New Jersey Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X GH2165 NJ Yes

Addresses

Primary practice location

230 Marlton Rd
Pilesgrove, NJ 08098-2718

Mailing address

2520 Wrangle Hill Rd Ste 200
Bear, DE 19701-3856
Phone (302) 365-8050

Other identifiers

IdentifierTypeStateIssuer
0463591MedicaidNJ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 11, 2016.

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1104206192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 WRANGLE HILL RD STE 200",
            "city": "BEAR",
            "state": "DE",
            "postal_code": "197013856",
            "telephone_number": "302-365-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 MARLTON RD",
            "city": "PILESGROVE",
            "state": "NJ",
            "postal_code": "080982718",
            "telephone_number": "856-241-3320",
            "fax_number": "856-241-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOSERV OF NEW JERSEY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVOSERV OF NEW JERSEY, INC.",
        "enumeration_date": "2015-06-04",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "BLOUGH",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "STATE DIRECTOR",
        "authorized_official_telephone_number": "856-241-3320",
        "authorized_official_credential": "M.S.W., BCABA"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NJ",
            "license": "GH2165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0463591",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pilesgrove, NJ

All providers in Pilesgrove, NJ · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey

Sources for this page

Verify at the official NPI Registry.