Provider Demographics
NPI:1598461550
Name:SAMBA RECOVERY AT PEACHTREE LLC
Entity Type:Organization
Organization Name:SAMBA RECOVERY AT PEACHTREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-642-1610
Mailing Address - Street 1:250 CEDARBRIDGE AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4236
Mailing Address - Country:US
Mailing Address - Phone:732-642-1610
Mailing Address - Fax:
Practice Address - Street 1:155 TECHNOLOGY PKWY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7002
Practice Address - Country:US
Practice Address - Phone:470-994-1114
Practice Address - Fax:470-994-1110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMBA RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility