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NPI Code Detail

MEDICARE: ADVOSERV OF NEW JERSEY, INC.

MEDICARE: ADVOSERV OF NEW JERSEY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityAT2674NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043690803
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVOSERV OF NEW JERSEY, INC.
Provider Business Mailing Address
First Line : 2520 WRANGLE HILL RD STE 200
Second Line :
City : BEAR
State : DE
Zip : 19701-3856
Country : US
Telephone Number : 302-365-8050
Fax Number :
Provider Business Practice Location Address
First Line : 241 LONGHOUSE DR
Second Line :
City : HEWITT
State : NJ
Zip : 07421-3731
Country : US
Telephone Number : 856-241-3320
Fax Number : 856-241-3321
Authorized Official
Title or Position : STATE DIRECTOR
Name : DARREN BLOUGH
Credential : M.S.W., BCABA
Telephone Number : 856-241-3320
Provider Enumeration Date : 06/05/2015
Last Update Date : 03/11/2016

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Directions to “ADVOSERV OF NEW JERSEY, INC. ” Practice Location

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