Healthcare Provider Details

I. General information

NPI: 1649711276
Provider Name (Legal Business Name): ADVOSERV OF NEW JERSEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 LA RUE ROAD
WEST MILFORD NJ
07480
US

IV. Provider business mailing address

510 HERON DR STE 114
SWEDESBORO NJ
08085-1767
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberGH2362
License Number StateNJ

VIII. Authorized Official

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