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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