Provider Demographics
NPI:1013246271
Name:MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:CRISFIELD PRP
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JARVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-742-7400
Mailing Address - Street 1:382 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-1329
Mailing Address - Country:US
Mailing Address - Phone:410-202-2750
Mailing Address - Fax:
Practice Address - Street 1:382 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817-1329
Practice Address - Country:US
Practice Address - Phone:410-202-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management