Provider Demographics
NPI:1619728953
Name:MARYVILLE, INC
Entity type:Organization
Organization Name:MARYVILLE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DONEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-227-2717
Mailing Address - Street 1:526 S BURNT MILL RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2205
Mailing Address - Country:US
Mailing Address - Phone:856-227-2717
Mailing Address - Fax:
Practice Address - Street 1:129 JOHNSON RD STE 7
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1777
Practice Address - Country:US
Practice Address - Phone:856-863-3913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health