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Advoserv of New Jersey, Inc.

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

NPI 1841702347 · NPPES record last updated Oct 25, 2017

Key facts

NPI
1841702347
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
17 Dogwood Cir
Pine Brook, NJ 07058-9723
Phone
(856) 241-3320
NPI assigned
Oct 25, 2017
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) 23

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 Yes

Addresses

Primary practice location

17 Dogwood Cir
Pine Brook, NJ 07058-9723

Mailing address

510 Heron Dr Ste 114
Swedesboro, NJ 08085-1767
Phone (856) 241-3320

Other identifiers

IdentifierTypeStateIssuer
0463591MedicaidNJ

Other providers in Pine Brook, NJ

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

Sources for this page

Verify at the official NPI Registry.