Provider Demographics
NPI:1528563897
Name:CROSSROADS TREATMENT CENTERS OF NEW JERSEY, PC
Entity Type:Organization
Organization Name:CROSSROADS TREATMENT CENTERS OF NEW JERSEY, PC
Other - Org Name:CROSSROADS TREATMENT CENTER OF TOMS RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-527-3145
Mailing Address - Street 1:55 BEATTIE PL STE 810
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2191
Mailing Address - Country:US
Mailing Address - Phone:864-527-3145
Mailing Address - Fax:864-990-0653
Practice Address - Street 1:751 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5032
Practice Address - Country:US
Practice Address - Phone:848-224-4578
Practice Address - Fax:848-224-4276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSROADS TREATMENT CENTER OF TOMS RIVER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-28
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X, 261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No251S00000XAgenciesCommunity/Behavioral Health