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General NPI Number Information
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NPI Number | 1437378379
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY BEHAVIORAL HEALTH RESOURCES INCORPORATED
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 212 MADISON AVE E
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City | MAGNOLIA
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State | NJ
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Zip | 08049-1409
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Country | US
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Telephone | 856-541-1700
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Fax | 856-309-9716
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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 | 856-488-1450
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | THERESA C WILSON
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Credential | MSW LCSW
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Telephone | 856-541-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 403010348
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License Number State | NJ
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Taxonomy #2
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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 | 40301D050041
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License Number State | NJ
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Taxonomy #3
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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 | 40301D050240
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 403010205
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License Number State | NJ
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