Advoserv of New Jersey, Inc.
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Mullica Hill, NJ
NPI 1922488089 · NPPES record last updated Mar 11, 2016
Key facts
- NPI
- 1922488089
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- License
- GH1250 (NJ)
- Legal business name
- ADVOSERV OF NEW JERSEY, INC.
- Practice address
- 1313 Ellis Mill Rd
Mullica Hill, NJ 08062-4431 - 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) 17
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 | GH1250 | NJ | Yes |
Addresses
Primary practice location
1313 Ellis Mill Rd
Mullica Hill, NJ 08062-4431
Mailing address
2520 Wrangle Hill Rd Ste 200
Bear, DE 19701-3856
Phone (302) 365-8050
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0463591 | Medicaid | NJ |
Other providers in Mullica Hill, NJ
- Ryan R Ackerman
- Advanced Cardiology of South Jersey
- Advoserv of New Jersey, Inc.
- Advoserv of New Jersey, Inc.
- Advoserv of New Jersey, Inc.
- Temitope Agabalogun
- Ejaz Ahmad
- Javerea Ahmed
- Bassil Akach
- Ihechi Akwuole
All providers in Mullica Hill, 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 Mar 11, 2016. 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.