Organization · Type 2 NPI

Ambrosia of Medford LLC

Substance Abuse Rehabilitation Facility · Medford, NJ

NPI number 1174117964 Active

Practice location

285 Old Marlton Pike
Medford, NJ 08055-8761

Call (714) 828-1800 Map

Fax (714) 882-1186

Mailing address

18401 Von Karman Ave Ste 500
Irvine, CA 92612-8531

Other practice locations

283 Old Marlton Pike, Medford, NJ 08055-8761 · (714) 828-1800

Specialties and licenses

Taxonomy	Code	License
Substance Abuse Rehabilitation Facility Primary	324500000X	None listed

Substance Abuse Rehabilitation Facility: A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

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NPI record

NPI: 1174117964
Entity type: Organization (Type 2)
Issued: Feb 23, 2021
Last updated: May 8, 2023
Status: Active
Subpart: Yes of Ambrosia of Medford LLC

Other names

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Pinelands Recovery Center of Medford · doing business as

Authorized official

Magdalen Gustilo
Director of Payer Relations
(714) 568-7667

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1174117964

Ambrosia of Medford LLC's National Provider Identifier is 1174117964, issued on Feb 23, 2021. The primary taxonomy on file is Substance Abuse Rehabilitation Facility (324500000X), and the practice location is in Medford, NJ. The record was last updated on May 8, 2023.