Provider Demographics
NPI:1629130729
Name:SERV CENTERS OF NEW JERSEY, INC
Entity Type:Organization
Organization Name:SERV CENTERS OF NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN NOSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-406-0100
Mailing Address - Street 1:380 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:W TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628
Mailing Address - Country:US
Mailing Address - Phone:609-406-0100
Mailing Address - Fax:609-406-0307
Practice Address - Street 1:111 NORTH AVENUE WEST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016
Practice Address - Country:US
Practice Address - Phone:908-276-3359
Practice Address - Fax:609-276-2472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4040322D00000X
NJ50004X42Y207322D00000X
NJ50004X42Y307322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8535906Medicaid