Provider Demographics
NPI:1053860130
Name:JOHN BROOKS RECOVERY CENTER
Entity Type:Organization
Organization Name:JOHN BROOKS RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-345-2020
Mailing Address - Street 1:660 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232
Mailing Address - Country:US
Mailing Address - Phone:609-345-2020
Mailing Address - Fax:609-646-7027
Practice Address - Street 1:660 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232
Practice Address - Country:US
Practice Address - Phone:609-345-2020
Practice Address - Fax:609-646-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000079261QF0400X
NJ2000275261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)