Organization
MARYVILLE, INC.
Active
Organization
MARYVILLE, INC.
Active
Parent organization
MARYVILLE, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARYVILLE, INC.
Authorized official
MR. JAMES O'BRIEN MSW, LCADC (CEO)
(256) 227-2717
Entity
Organization
Contact information
Practice address
567 SALEM-QUINTON RD, SALEM, NJ 08079
(856) 935-9305
(856) 935-9269
Mailing address
567 SALEM-QUINTON RD, SALEM, NJ 08079
(856) 935-9305
(856) 935-9269
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
23016
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7632401
—
NJ
Enumeration date
05/03/2007
Last updated
04/07/2010
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