Ambrosia of Medford LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

AMBROSIA OF MEDFORD LLC

Doing business as

Pinelands Recovery Center of Medford

Practice address

285 Old Marlton Pike
Medford, NJ 08055-8761

Phone

(714) 828-1800

Fax

(714) 882-1186

NPI assigned

Feb 23, 2021

Organization subpart

Yes

Parent organization

AMBROSIA OF MEDFORD LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Magdalen Gustilo

Title

Director of Payer Relations

Phone

(714) 568-7667

Specialties & licenses 1

Addresses

Other names 1

• Pinelands Recovery Center of Medford Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Ambrosia of Medford LLC2 organizations share this tax ID, including this one

Part of

Ambrosia of Medford LLC

Other organizations with this tax ID 1

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

• Ambrosia of Medford LLC

  dba Pinelands Recovery Center of Medford

  • Substance Abuse Rehabilitation Facility
  • Medford, NJ
  • NPI 1770055428
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683504000000",
    "number": "1174117964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18401 VON KARMAN AVE STE 500",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926128531",
            "telephone_number": "714-828-1800",
            "fax_number": "714-882-1186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 OLD MARLTON PIKE",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558761",
            "telephone_number": "714-828-1800",
            "fax_number": "714-882-1186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "283 Old Marlton Pike",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "NJ",
            "postal_code": "080558761",
            "country_code": "US",
            "telephone_number": "714-828-1800",
            "fax_number": "714-882-1186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AMBROSIA OF MEDFORD LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMBROSIA OF MEDFORD LLC",
        "enumeration_date": "2021-02-23",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "GUSTILO",
        "authorized_official_first_name": "MAGDALEN",
        "authorized_official_title_or_position": "DIRECTOR OF PAYER RELATIONS",
        "authorized_official_telephone_number": "714-568-7667"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pinelands Recovery Center of Medford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allies, Inc.
• Allison Epstein, Ma, LPC, LLC
• Bernadette Alpajora, OTD
• Elpi Niki Altum, PT
• Rianna M Alvarado, AA, RBT CERT
• Ambrosia of Medford LLC (Pinelands Recovery Center of Medford)
• Ambrosia of New Jersey LLC (Pinelands Recovery Center of Medford)
• Elizabeth Backer Amisson, MS, RD, CDE
• Meaghan Marie Andre-Brown, D.O.
• Justin Andronico

• Substance Abuse Rehabilitation Facility in Medford, NJ
• Providers in Medford, NJ by specialty
• Substance Abuse Rehabilitation Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.