Provider Demographics
NPI: | 1790308708 |
---|---|
Name: | JOHN BROOKS RECOVERY CENTER , A NEW JERSEY NONPROFIT CORPORATION |
Entity Type: | Organization |
Organization Name: | JOHN BROOKS RECOVERY CENTER , A NEW JERSEY NONPROFIT CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | EDWARD |
Authorized Official - Middle Name: | JOHN |
Authorized Official - Last Name: | PALLIES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 609-345-2020 |
Mailing Address - Street 1: | 660 BLACK HORSE PIKE |
Mailing Address - Street 2: | |
Mailing Address - City: | PLEASANTVILLE |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08232-2360 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-345-2020 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1455 PINEWOOD BLVD |
Practice Address - Street 2: | |
Practice Address - City: | MAYS LANDING |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08330 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-345-2020 |
Practice Address - Fax: | 609-646-7027 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-05-26 |
Last Update Date: | 2020-05-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |