Provider Demographics
NPI:1144728700
Name:MIDLAND ADULT SERVICES, INC.
Entity type:Organization
Organization Name:MIDLAND ADULT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCINERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-722-8222
Mailing Address - Street 1:PO BOX 5026
Mailing Address - Street 2:94 READINGTON ROAD
Mailing Address - City:NORTH BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORAL LANGDON WAY
Practice Address - Street 2:APT 102
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-3407
Practice Address - Country:US
Practice Address - Phone:908-704-2365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0484831Medicaid