NPIMap

Maryville, Inc.

Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Vineland, NJ

NPI 1457573842 · NPPES record last updated Aug 1, 2018

Key facts

NPI
1457573842
Entity type
Organization (NPI type 2)
Primary specialty
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
License
22932 (NJ)
Legal business name
MARYVILLE, INC.
Practice address
1173 East Landis Ave
Vineland, NJ 08360
Phone
(856) 690-1000
Fax
(856) 690-1764
NPI assigned
May 3, 2007
Organization subpart
Yes
Parent organization (as reported)
MARYVILLE, INC.

Authorized official

Name
Mr. Jared Levy
Title
Cfo
Phone
(856) 863-3913

Corporate family (same tax ID) 14

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

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
Maryville Inc (15 organizations share this tax ID)
Part of
Maryville Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 22932 NJ Yes

Addresses

Primary practice location

1173 East Landis Ave
Vineland, NJ 08360

Mailing address

1173 East Landis Ave
Vineland, NJ 08360
Phone (856) 690-1000

Other identifiers

IdentifierTypeStateIssuer
7706405MedicaidNJ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 1, 2018.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1457573842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1173 EAST LANDIS AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08360",
            "telephone_number": "856-690-1000",
            "fax_number": "856-690-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1173 EAST LANDIS AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08360",
            "telephone_number": "856-690-1000",
            "fax_number": "856-690-1764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVILLE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARYVILLE, INC.",
        "enumeration_date": "2007-05-03",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "LEVY",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "856-863-3913",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NJ",
            "license": "22932",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7706405",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

All providers in Vineland, NJ · Substance Use Disorder Rehabilitation Clinic/Center in New Jersey

Sources for this page

Verify at the official NPI Registry.