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General NPI Number Information
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NPI Number | 1326554882
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Entity Type | Organization
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Legal Business Name | ENLIGHTENED SOLUTIONS DETOX LLC
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1501 N ALBANY AVE
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-1209
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Country | US
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Telephone | 609-270-4006
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 N ALBANY AVE
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-1209
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Country | US
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Telephone | 609-270-4006
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ROB M SNYDER
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Credential |
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Telephone | 609-270-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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