Advoserv of New Jersey, Inc.
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Pilesgrove, NJ
NPI 1477050987 · NPPES record last updated Apr 11, 2018
Key facts
- NPI
- 1477050987
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Legal business name
- ADVOSERV OF NEW JERSEY, INC.
- Practice address
- 21 Two Penny Run W
Pilesgrove, NJ 08098-2643 - Phone
- (856) 241-3320
- NPI assigned
- Apr 11, 2018
- Organization subpart
- Yes
- Parent organization (as reported)
- ADVOSERV OF NEW JERSEY, INC.
Authorized official
- Name
- Michael Wilder, MHSA
- Title
- Senior VP of Operations
- Phone
- (856) 241-3320
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Advoserv of New Jersey Inc
- Part of
- Advoserv of New Jersey Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
21 Two Penny Run W
Pilesgrove, NJ 08098-2643
Mailing address
510 Heron Dr Ste 114
Swedesboro, NJ 08085-1767
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0463591 | Medicaid | NJ |
NPI Registry JSON
{
"created_epoch": "1523404800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1523404800000",
"number": "1477050987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 HERON DR STE 114",
"city": "SWEDESBORO",
"state": "NJ",
"postal_code": "080851767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 TWO PENNY RUN W",
"city": "PILESGROVE",
"state": "NJ",
"postal_code": "080982643",
"telephone_number": "856-241-3320"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVOSERV OF NEW JERSEY, INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ADVOSERV OF NEW JERSEY, INC.",
"enumeration_date": "2018-04-11",
"last_updated": "2018-04-11",
"status": "A",
"authorized_official_last_name": "WILDER",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "SENIOR VP OF OPERATIONS",
"authorized_official_telephone_number": "856-241-3320",
"authorized_official_credential": "MHSA"
},
"taxonomies": [
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0463591",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pilesgrove, NJ
- Advoserv of New Jersey, Inc.
- Advoserv of New Jersey, Inc.
- Advoserv of New Jersey, Inc.
- Advoserv of New Jersey, Inc.
- Advoserv of New Jersey, Inc.
- Allies, Inc.
- Allies, Inc.
- Allies, Inc.
- Kortney Babington
- Bancroft, a New Jersey Nonprofit Corporation
All providers in Pilesgrove, NJ · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.