Provider Demographics
NPI:1285014233
Name:ADVOSERV OF NEW JERSEY, INC.
Entity Type:Organization
Organization Name:ADVOSERV OF NEW JERSEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, BCABA
Authorized Official - Phone:856-241-3320
Mailing Address - Street 1:2520 WRANGLE HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3856
Mailing Address - Country:US
Mailing Address - Phone:302-365-8050
Mailing Address - Fax:
Practice Address - Street 1:53 ROBBINS RD
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3710
Practice Address - Country:US
Practice Address - Phone:856-241-3320
Practice Address - Fax:856-241-3321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOSERV OF NEW JERSEY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-04
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH1849320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0463591Medicaid