Organization
MARYVILLE, INC
Active
Other names
MRYVILLE ADDICTION TREATMENT CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
VERONICA J GADDEN (BILLING SUPERVISOR)
(856) 863-3913
Entity
Organization
Contact information
Practice address
610 PEMBERTON BROWNS MILLS RD, PEMBERTON, NJ 08068-1537
(609) 321-6263
(609) 283-0262
Mailing address
129 JOHNSON RD STE 7, TURNERSVILLE, NJ 08012-1777
(856) 863-3913
(856) 227-6499
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1000140
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000140
STATE OF NEW JERSEY OFFICE OF LICENSING
NJ
Enumeration date
02/20/2018
Last updated
02/20/2018
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