Healthcare Provider Details

I. General information

NPI: 1992232029
Provider Name (Legal Business Name): RECOVERY CENTERS OF AMERICA AT VOORHEES NJ MEDICAID ONLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date: 05/09/2018
Reactivation Date: 02/04/2019

III. Provider practice location address

2701 RENAISSANCE BLVD FL 4
KING OF PRUSSIA PA
19406-2781
US

IV. Provider business mailing address

2701 RENAISSANCE BLVD 4TH FLOOR
KING OF PRUSSIA PA
19406
US

V. Phone/Fax

Practice location:
  • Phone: 610-994-2968
  • Fax:
Mailing address:
  • Phone: 610-994-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK GALLIHUE
Title or Position: CORPORATE DIRECTOR, PATIENT ACCOUNT
Credential:
Phone: 610-994-2968