Provider Demographics
NPI:1528569928
Name:MIDLAND ADULT SERVICES, INC.
Entity Type:Organization
Organization Name:MIDLAND ADULT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCINERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-722-8222
Mailing Address - Street 1:PO BOX 5026
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
Mailing Address - Country:US
Mailing Address - Phone:908-722-8222
Mailing Address - Fax:908-722-3134
Practice Address - Street 1:2 CORPORAL LANGDON WAY
Practice Address - Street 2:APT 122
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844
Practice Address - Country:US
Practice Address - Phone:908-722-8222
Practice Address - Fax:908-722-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0484831Medicaid