Healthcare Provider Details

I. General information

NPI: 1437378379
Provider Name (Legal Business Name): SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date: 05/22/2008
Reactivation Date: 07/23/2008

III. Provider practice location address

212 MADISON AVE E
MAGNOLIA NJ
08049-1409
US

IV. Provider business mailing address

2500 MCCLELLAN AVE STE 300
PENNSAUKEN NJ
08109-0001
US

V. Phone/Fax

Practice location:
  • Phone: 856-541-1700
  • Fax: 856-309-9716
Mailing address:
  • Phone: 856-361-1100
  • Fax: 856-488-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number403010348
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number40301D050041
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number40301D050240
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number403010205
License Number StateNJ

VIII. Authorized Official

Name: THERESA C WILSON
Title or Position: PRESIDENT/CEO
Credential: MSW LCSW
Phone: 856-541-1700