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Advoserv of New Jersey, Inc.

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

NPI 1821478835 · NPPES record last updated Mar 11, 2016

Key facts

NPI
1821478835
Entity type
Organization (NPI type 2)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
License
GH743 (NJ)
Legal business name
ADVOSERV OF NEW JERSEY, INC.
Practice address
35 Grant Ave
Somerville, NJ 08876-2510
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) 24

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 GH743 NJ Yes

Addresses

Primary practice location

35 Grant Ave
Somerville, NJ 08876-2510

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
0463591MedicaidNJ

Other providers in Somerville, NJ

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

Sources for this page

Verify at the official NPI Registry.