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General NPI Number Information
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NPI Number | 1306365671
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES, INC.
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 09/18/2017
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Provider Practice Location Address
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Address Line | 4 EGG HARBOR RD
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City | BERLIN
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State | NJ
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Zip | 08009-2019
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Country | US
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Telephone | 856-309-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 MCCLELLAN AVE STE 300
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-0001
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Country | US
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Telephone | 856-361-1100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | THERESA WILSON
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Credential |
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Telephone | 856-655-1211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 40301D051040
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License Number State | NJ
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