Provider Demographics
NPI:1174123582
Name:SUMMIT BHC NEW JERSEY, LLC
Entity type:Organization
Organization Name:SUMMIT BHC NEW JERSEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-716-4924
Mailing Address - Street 1:389 NICHOL MILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4887
Mailing Address - Country:US
Mailing Address - Phone:877-463-3553
Mailing Address - Fax:615-435-3725
Practice Address - Street 1:133 POLK LN
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-5905
Practice Address - Country:US
Practice Address - Phone:856-455-7575
Practice Address - Fax:865-453-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility