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General NPI Number Information
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NPI Number | 1184833550
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY DRUG TREATMENT CENTER
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 162 SUNNY SLOPE DR
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City | BRIDGETON
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State | NJ
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Zip | 08302-5732
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Country | US
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Telephone | 856-455-5441
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Fax | 856-455-0505
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Provider Business Mailing Address
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Address Line | PO BOX 867
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City | BRIDGETON
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State | NJ
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Zip | 08302-0457
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Country | US
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Telephone | 856-455-5441
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Fax | 856-455-0505
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MARY I REIMER
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Credential | LPC, LCADC, ACS, CCS
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Telephone | 609-805-2986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 22415
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License Number State | NJ
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