Healthcare Provider Details

I. General information

NPI: 1851803167
Provider Name (Legal Business Name): MGM COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 BECKLEY DR
WILLIAMSTOWN NJ
08094-8808
US

IV. Provider business mailing address

1056 BECKLEY DR
WILLIAMSTOWN NJ
08094-8808
US

V. Phone/Fax

Practice location:
  • Phone: 856-885-2120
  • Fax: 856-885-2644
Mailing address:
  • Phone: 856-885-2120
  • Fax: 856-885-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEMLEY WHITESIDE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 856-885-2120