Healthcare Provider Details

I. General information

NPI: 1043023773
Provider Name (Legal Business Name): DESIREE COOPER-GILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RECOVERY CENTERS OF AMERICA AT LIGHTHOUSE 5034 ATLANTIC AVENUE
MAYS LANDING NJ
08330
US

IV. Provider business mailing address

106 CARLSBAD CT
EGG HARBOR TWP NJ
08234-5877
US

V. Phone/Fax

Practice location:
  • Phone: 609-782-0005
  • Fax:
Mailing address:
  • Phone: 609-377-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number26NR22830800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: