Provider Demographics
NPI:1093972838
Name:CAMDEN TREATMENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:CAMDEN TREATMENT ASSOCIATES LLC
Other - Org Name:URBAN TREATMENT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACALUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-338-1811
Mailing Address - Street 1:508 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104-1108
Mailing Address - Country:US
Mailing Address - Phone:856-338-1811
Mailing Address - Fax:856-338-1753
Practice Address - Street 1:508 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104-1108
Practice Address - Country:US
Practice Address - Phone:856-338-1811
Practice Address - Fax:856-338-1753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22997261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0217719Medicaid