Provider Demographics
NPI:1467852798
Name:COLLEGE RECOVERY LLC
Entity Type:Organization
Organization Name:COLLEGE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-806-9662
Mailing Address - Street 1:104 BAYARD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2102
Mailing Address - Country:US
Mailing Address - Phone:917-806-9662
Mailing Address - Fax:
Practice Address - Street 1:23 DUKE ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1738
Practice Address - Country:US
Practice Address - Phone:732-402-0677
Practice Address - Fax:732-626-6797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1000153OtherDEPT OF HUMAN SERVICES
NJ2000540OtherDEPT OF HUMAN SERVICES