1144728700 NPI number — MIDLAND ADULT SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144728700 NPI number — MIDLAND ADULT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDLAND ADULT SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144728700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5026
Provider Second Line Business Mailing Address:
94 READINGTON ROAD
Provider Business Mailing Address City Name:
NORTH BRANCH
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CORPORAL LANGDON WAY
Provider Second Line Business Practice Location Address:
APT 102
Provider Business Practice Location Address City Name:
HILLSBOROUGH
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08844-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-704-2365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MCINERNEY
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
908-722-8222

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0484831 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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