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General NPI Number Information
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NPI Number | 1750870358
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Entity Type | Organization
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Legal Business Name | ADVOSERV OF NEW JERSEY, INC.
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 1155 GLENWOOD CT
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City | VINELAND
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State | NJ
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Zip | 08361-8510
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Country | US
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Telephone | 856-241-3320
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Fax |
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Provider Business Mailing Address
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Address Line | 510 HERON DR STE 114
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City | SWEDESBORO
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State | NJ
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Zip | 08085-1767
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR VP OF OPERATIONS
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Name | MICHAEL WILDER
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Credential | MHSA
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Telephone | 856-241-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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