Healthcare Provider Details

I. General information

NPI: 1174649685
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: 03/22/2007
Last Update Date: 07/21/2022
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BLACK HORSE PIKE
PLEASANTVILLE NJ
08232
US

IV. Provider business mailing address

660 BLACK HORSE PIKE
PLEASANTVILLE NJ
08232
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 Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number2000275
License Number StateNJ

VIII. Authorized Official

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