Healthcare Provider Details

I. General information

NPI: 1760002331
Provider Name (Legal Business Name): SEABROOK HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MARLTON PIKE E STE O77
CHERRY HILL NJ
08003-4204
US

IV. Provider business mailing address

133 POLK LANE
SEABROOK NJ
08302-5055
US

V. Phone/Fax

Practice location:
  • Phone: 856-663-0010
  • Fax: 856-375-2000
Mailing address:
  • Phone: 856-455-7575
  • Fax: 856-391-6019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CRYSTAL REBECCA SMITH
Title or Position: QUALITY MANAGER
Credential:
Phone: 856-455-7575