Provider Demographics
NPI:1184833550
Name:SOUTH JERSEY DRUG TREATMENT CENTER
Entity Type:Organization
Organization Name:SOUTH JERSEY DRUG TREATMENT CENTER
Other - Org Name:SJDTC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-455-5441
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-0457
Mailing Address - Country:US
Mailing Address - Phone:856-455-5441
Mailing Address - Fax:856-455-0505
Practice Address - Street 1:162 SUNNY SLOPE DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-0457
Practice Address - Country:US
Practice Address - Phone:856-455-5441
Practice Address - Fax:856-455-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22415261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0102105Medicaid