Provider Demographics
NPI:1437558194
Name:ADVOSERV NJ, INC.
Entity Type:Organization
Organization Name:ADVOSERV NJ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-365-8050
Mailing Address - Street 1:2520 WRANGLE HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3849
Mailing Address - Country:US
Mailing Address - Phone:302-365-8050
Mailing Address - Fax:
Practice Address - Street 1:2520 WRANGLE HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3849
Practice Address - Country:US
Practice Address - Phone:302-365-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GI ADVO OPCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities