Healthcare Provider Details

I. General information

NPI: 1598145351
Provider Name (Legal Business Name): ADVOSERV OF NEW JERSEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 UNION VALLEY RD
WEST MILFORD NJ
07480-2232
US

IV. Provider business mailing address

2520 WRANGLE HILL RD STE 200
BEAR DE
19701-3856
US

V. Phone/Fax

Practice location:
  • Phone: 856-241-3320
  • Fax: 856-241-3321
Mailing address:
  • Phone: 302-365-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberAT2676
License Number StateNJ

VIII. Authorized Official

Name: DARREN BLOUGH
Title or Position: STATE DIRECTOR
Credential: M.S.W., BCABA
Phone: 856-241-3320