NPIMap

Organization Active NPI

Maryville, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Salem, NJ
National Provider Identifier
1205058567
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
23016 Issued in NJ
Legal business name
MARYVILLE, INC.
Practice address
567 Salem-Quinton Rd
Salem, NJ 08079
Phone
(856) 935-9305
Fax
(856) 935-9269
NPI assigned
May 3, 2007
Last updated
Apr 7, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
MARYVILLE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Authorized official

Name
Mr. James O'Brien, MSW, LCADC
Title
Ceo
Phone
(256) 227-2717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 23016 NJ Primary

Addresses

Primary practice location

567 Salem-Quinton Rd
Salem, NJ 08079

Mailing address

567 Salem-Quinton Rd
Salem, NJ 08079
Phone (856) 935-9305

Other identifiers 1

IdentifierTypeStateIssuer
7632401MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Maryville Inc15 organizations share this tax ID, including this one
Part of
Maryville Inc

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1205058567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "567 SALEM-QUINTON RD",
            "city": "SALEM",
            "state": "NJ",
            "postal_code": "08079",
            "telephone_number": "856-935-9305",
            "fax_number": "856-935-9269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "567 SALEM-QUINTON RD",
            "city": "SALEM",
            "state": "NJ",
            "postal_code": "08079",
            "telephone_number": "856-935-9305",
            "fax_number": "856-935-9269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVILLE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARYVILLE, INC.",
        "enumeration_date": "2007-05-03",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "256-227-2717",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LCADC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NJ",
            "license": "23016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7632401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.