Provider Demographics
NPI:1750684213
Name:PINNACLE TREATMENT CENTERS NJ-IV
Entity Type:Organization
Organization Name:PINNACLE TREATMENT CENTERS NJ-IV
Other - Org Name:ENDEAVOR HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP/CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-264-3824
Mailing Address - Street 1:25 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-1562
Mailing Address - Country:US
Mailing Address - Phone:732-264-3824
Mailing Address - Fax:732-264-6497
Practice Address - Street 1:6 BROADWAY
Practice Address - Street 2:
Practice Address - City:KEYPORT
Practice Address - State:NJ
Practice Address - Zip Code:07735-1038
Practice Address - Country:US
Practice Address - Phone:732-264-3824
Practice Address - Fax:732-264-6497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder