Healthcare Provider Details

I. General information

NPI: 1306365671
Provider Name (Legal Business Name): SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EGG HARBOR RD
BERLIN NJ
08009-2019
US

IV. Provider business mailing address

2500 MCCLELLAN AVE STE 300
PENNSAUKEN NJ
08109-0001
US

V. Phone/Fax

Practice location:
  • Phone: 856-309-6070
  • Fax:
Mailing address:
  • Phone: 856-361-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number40301D051040
License Number StateNJ

VIII. Authorized Official

Name: THERESA WILSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 856-655-1211