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PINELANDS RECOVERY CENTER OF MEDFORD
NPI 1174117964
Substance Abuse Rehabilitation Facility in Medford, NJ

Active since February 23, 2021CLIA Certified · 2 labs
285 OLD MARLTON PIKE, MEDFORD, NJ 08055(714) 828-1800(714) 882-1186 Get Directions Write a Review

NPPES record last updated: May 8, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 8, 2023, Feb 23, 2021 (2 updates tracked since 2021).

About Pinelands Recovery Center Of Medford NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PINELANDS RECOVERY CENTER OF MEDFORD (NPI 1174117964) is a healthcare organization registered as a substance abuse rehabilitation facility in Medford, New Jersey and active in the NPI registry since February 2021. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Medford, and lists Magdalen Gustilo, Director Of Payer Relations, as its authorized official.

NPPES Registry Identity

NPI1174117964
Entity TypeOrganization
Primary Taxonomy324500000X
Legal Business NameAMBROSIA OF MEDFORD LLC
Location Address285 OLD MARLTON PIKEMedford, NJ 08055-8761
Mailing Address18401 Von Karman Ave Ste 500Irvine, CA 92612-8531 · (714) 828-1800 · Fax (714) 882-1186
Phone(714) 828-1800
Fax(714) 882-1186
Organization SubpartYes
Authorized OfficialMagdalen GustiloDirector Of Payer Relations · (714) 568-7667
Enumeration DateFebruary 23, 2021
Last NPPES UpdateMay 8, 20232 updates tracked since enumeration
NPPES CertifiedMay 8, 2023
✔ NPI 1174117964 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySubstance Abuse Rehabilitation FacilityResidential Treatment Facilities
Taxonomy Code324500000X
Definition
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.
285 OLD MARLTON PIKE, Medford, NJ 08055
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Other Names 1

Doing Business AsPinelands Recovery Center Of Medford

Secondary Practice Location 1

Location 1283 Old Marlton PikeMedford, NJ 08055-8761 · Phone (714) 828-1800 · Fax (714) 882-1186

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D2233477

Pinelands Recovery Center Of Medford · Medford, NJ
Active · expires Aug 23, 2027
CLIA Number31D2233477
Laboratory TypeResidential Treatment
Certificate Effective DateAugust 24, 2025
Certificate Expiration DateAugust 23, 2027
Laboratory DirectorDavid Gigliotti
Laboratory Phone(609) 678-0870
Laboratory LocationPinelands Recovery Center Of Medford285 Old Marlton Pike, Medford, NJ 08055
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 31D2153638

Pinelands Recovery Center Of Medford · Medford, NJ
Active · expires Aug 27, 2026
CLIA Number31D2153638
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 28, 2024
Certificate Expiration DateAugust 27, 2026
Laboratory DirectorDavid Gigliotti
Laboratory Phone(609) 678-0370
Laboratory LocationPinelands Recovery Center Of Medford283 Old Marlton Pike, Medford, NJ 08055
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ambrosia Of Medford LLC's NPI number?

The NPI number for Ambrosia Of Medford LLC is 1174117964. It was assigned to this organization in the NPPES registry on February 23, 2021. The provider is doing business as Pinelands Recovery Center Of Medford.

Where is Ambrosia Of Medford LLC located?

Ambrosia Of Medford LLC is located at 285 Old Marlton Pike, Medford, NJ 08055. The listed phone number is (714) 828-1800.

What is Ambrosia Of Medford LLC's specialty?

The primary specialty registered for this NPI is Substance Abuse Rehabilitation Facility with taxonomy code 324500000X.

Does Ambrosia Of Medford LLC hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Ambrosia Of Medford LLC was last updated on May 8, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.