Provider Demographics
NPI:1790210342
Name:QMANJ, INC.
Entity type:Organization
Organization Name:QMANJ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE AND INFORMATION
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:856-735-1041
Mailing Address - Street 1:700 CINNAMINSON AVE
Mailing Address - Street 2:BLDG B
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065-2500
Mailing Address - Country:US
Mailing Address - Phone:856-735-1034
Mailing Address - Fax:
Practice Address - Street 1:213 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1803
Practice Address - Country:US
Practice Address - Phone:856-354-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJGH1355320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1578908943Medicaid