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NPI Code Detail

MEDICARE: 5034 ATLANTIC AVENUE OPCO, LLC

MEDICARE: 5034 ATLANTIC AVENUE OPCO, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1841757846
Entity Type Code : Organization
Provider Name (Legal Business Name) : 5034 ATLANTIC AVENUE OPCO, LLC
Provider Business Mailing Address
First Line : 2201 RENAISSANCE BLVD
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-2709
Country : US
Telephone Number : 610-994-2900
Fax Number :
Provider Business Practice Location Address
First Line : 901 ERNSTON RD
Second Line :
City : SOUTH AMBOY
State : NJ
Zip : 08879-2000
Country : US
Telephone Number : 732-585-1815
Fax Number :
Authorized Official
Title or Position : CFO
Name : SERGE CRUZ
Credential :
Telephone Number : 610-427-9434
Provider Enumeration Date : 02/26/2019
Last Update Date : 12/18/2024

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