Provider Demographics
NPI:1770796575
Name:IRON RECOVERY AND WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:IRON RECOVERY AND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:609-394-8988
Mailing Address - Street 1:132 PERRY STREET
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3968
Mailing Address - Country:US
Mailing Address - Phone:609-394-8988
Mailing Address - Fax:609-396-5856
Practice Address - Street 1:132 PERRY STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3968
Practice Address - Country:US
Practice Address - Phone:609-394-8988
Practice Address - Fax:609-396-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2000345261Q00000X, 261QM1300X
NJNJ-10046-M261QM2800X
NJ2000345; 2000078261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2000078OtherDHS LICENSE- AMBULATORY CARE CONSISTING OF ADDICTION SERVICES
NJ7603606OtherWFNJ-SAI GROUP PROVIDER ID- INDEP CLINIC NARCOTIC & DRUG ABUSE TX
NJ183739 YBA4OtherMEDICARE PROVIDER ID W/ AGENCY GROUP SUFFIX
NJ0102903OtherNJ MEDICAID PROVIDER ID: INDEPENDENT CLINIC- NARCOTIC & DRUG ABUSE
NJ215114000OtherMAGELLAN MIS
NJNJ-10046-MOtherSUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
NJ2000345 MV1-10OtherDHS DMHAS MOBILE UNIT LICENSE #
NJ2000345OtherDHS LICENSE- AMBULATORY CARE CONSISTING OF ADDICTION SERVICES & OTP
NJ7603606OtherWFNJ-SAI GROUP PROVIDER ID- INDEP CLINIC NARCOTIC & DRUG ABUSE TX