Provider Demographics
NPI:1780134486
Name:MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIRU
Authorized Official - Middle Name:
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-740-7400
Mailing Address - Street 1:23704 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837-2101
Mailing Address - Country:US
Mailing Address - Phone:410-742-7400
Mailing Address - Fax:410-742-6452
Practice Address - Street 1:23704 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:MARDELA SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:21837-2101
Practice Address - Country:US
Practice Address - Phone:410-742-7400
Practice Address - Fax:410-742-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-979385H00000X
MD1709385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care