| Organization Name: | MARYVILLE, INC |
| NPI Number: | 1225262629 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES BROWN (CHIEF OPERATING OFFICER) |
| Mailing Address: | 707 N Main St Suite 2 Glassboro |
| State: | NJ US |
| Postal Code: | 080281605 |
| Phone Number: | 8568633913 |
| Fax Number: | 8568633917 |
| NPI Enumeration Date: | 05/13/2009 |
| NPI Last Update Date: | 05/13/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 20000132 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |