Provider Demographics
NPI:1073914313
Name:SERVICES TO OVERCOME DRUG ABUSE AMONG TEENAGERS, INC.
Entity Type:Organization
Organization Name:SERVICES TO OVERCOME DRUG ABUSE AMONG TEENAGERS, INC.
Other - Org Name:SODAT OF NEW JERSEY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-475-1310
Mailing Address - Street 1:919 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-1436
Mailing Address - Country:US
Mailing Address - Phone:856-475-1310
Mailing Address - Fax:856-742-0031
Practice Address - Street 1:124 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-475-1310
Practice Address - Fax:856-742-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40840261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0412911Medicaid
NJ0412911Medicaid
NJ0441767Medicaid