Provider Demographics
NPI:1275008542
Name:JOHN BROOKS RECOVERY CENTER
Entity Type:Organization
Organization Name:JOHN BROOKS RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PALLIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-345-2020
Mailing Address - Street 1:660 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232
Mailing Address - Country:US
Mailing Address - Phone:609-345-2020
Mailing Address - Fax:603-646-7027
Practice Address - Street 1:1315 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7204
Practice Address - Country:US
Practice Address - Phone:609-345-2020
Practice Address - Fax:609-345-0952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility