Provider Demographics
NPI:1902944853
Name:SERV CENTERS OF NEW JERSEY, INC
Entity Type:Organization
Organization Name:SERV CENTERS OF NEW JERSEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDDOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-406-0100
Mailing Address - Street 1:20 SCOTCH RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-2503
Mailing Address - Country:US
Mailing Address - Phone:609-406-0100
Mailing Address - Fax:609-406-0307
Practice Address - Street 1:532 W STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5627
Practice Address - Country:US
Practice Address - Phone:609-394-0212
Practice Address - Fax:609-394-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJL41-C1320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0084301Medicaid