=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386108850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REMED RECOVERY CARE CENTERS OF NEW JERSEY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2019
-----------------------------------------------------
Last Update Date | 01/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 557 CRANBURY RD STE 14
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-595-9300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 INDUSTRIAL BLVD STE 203
-----------------------------------------------------
City | PAOLI
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19301-1609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-595-9300
-----------------------------------------------------
Fax | 484-595-0365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | MR. CHARLES A. MCCARTNEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-595-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------