Provider Demographics
NPI:1639659899
Name:SERVICES TO OVERCOME DRUG ABUSE AMONG TEENAGERS, INC.
Entity Type:Organization
Organization Name:SERVICES TO OVERCOME DRUG ABUSE AMONG TEENAGERS, INC.
Other - Org Name:SODAT OF NJ, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-475-1310
Mailing Address - Street 1:919 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08093-1436
Mailing Address - Country:US
Mailing Address - Phone:856-475-1310
Mailing Address - Fax:
Practice Address - Street 1:92-94 VINE ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2444
Practice Address - Country:US
Practice Address - Phone:856-453-5713
Practice Address - Fax:856-453-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ301309261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0315729Medicaid
NJ0459011OtherSAI - WORKFIRST