Provider Demographics
NPI:1184244691
Name:SEABROOK HOUSE, INC.
Entity type:Organization
Organization Name:SEABROOK HOUSE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QUALITY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-455-7575
Mailing Address - Street 1:133 POLK LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-5905
Mailing Address - Country:US
Mailing Address - Phone:856-455-7575
Mailing Address - Fax:
Practice Address - Street 1:223 POLK LN
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-5904
Practice Address - Country:US
Practice Address - Phone:856-455-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEABROOK HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0697541Medicaid