Organization
MARYVILLE, INC.
Active
Parent organization
MARYVILLE, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARYVILLE, INC.
Authorized official
MR. JARED LEVY (CFO)
(856) 863-3913
Entity
Organization
Contact information
Practice address
1173 EAST LANDIS AVE, VINELAND, NJ 08360
(856) 690-1000
(856) 690-1764
Mailing address
1173 EAST LANDIS AVE, VINELAND, NJ 08360
(856) 690-1000
(856) 690-1764
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
22932
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7706405
—
NJ
Enumeration date
05/03/2007
Last updated
08/01/2018
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