Healthcare Provider Details

I. General information

NPI: 1902425077
Provider Name (Legal Business Name): JOHN BROOKS RECOVERY CENTER , A NEW JERSEY NONPROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2360
US

IV. Provider business mailing address

660 BLACK HORSE PIKE
PLEASANTVILLE NJ
08232-2360
US

V. Phone/Fax

Practice location:
  • Phone: 609-345-2020
  • Fax:
Mailing address:
  • Phone: 609-345-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD JOHN PALLIES
Title or Position: CFO
Credential:
Phone: 609-345-2020