Provider Demographics
NPI:1154858520
Name:RECOVERY CENTERS OF AMERICA AT VENTNOR NJ MEDICAID ONLY
Entity Type:Organization
Organization Name:RECOVERY CENTERS OF AMERICA AT VENTNOR NJ MEDICAID ONLY
Other - Org Name:RECOVERY CENTERS OF AMERICA AT VENTNOR
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-994-2900
Mailing Address - Street 1:2201 RENAISSANCE BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2709
Mailing Address - Country:US
Mailing Address - Phone:610-994-2900
Mailing Address - Fax:
Practice Address - Street 1:6601 VENTNOR AVE STE 12
Practice Address - Street 2:
Practice Address - City:VENTNOR CITY
Practice Address - State:NJ
Practice Address - Zip Code:08406-2172
Practice Address - Country:US
Practice Address - Phone:610-994-2900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRC-OC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-17
Last Update Date:2023-02-09
Deactivation Date:2018-04-24
Deactivation Code:
Reactivation Date:2019-02-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder