Healthcare Provider Details

I. General information

NPI: 1700328283
Provider Name (Legal Business Name): VICTORY BAY RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CHEWS LANDING ROAD
LAUREL SPRINGS NJ
08021
US

IV. Provider business mailing address

1395 CHEWS LANDING ROAD
LAUREL SPRINGS NJ
08021
US

V. Phone/Fax

Practice location:
  • Phone: 856-282-2050
  • Fax: 856-352-6713
Mailing address:
  • Phone: 856-282-2050
  • Fax: 856-352-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRIS MCGOLDRICK
Title or Position: DIRECTOR OF ADMISSION
Credential:
Phone: 800-253-0673