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General NPI Number Information
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NPI Number | 1467852798
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Entity Type | Organization
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Legal Business Name | COLLEGE RECOVERY LLC
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 23 DUKE ST
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1738
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Country | US
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Telephone | 732-402-0677
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Fax | 732-626-6797
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Provider Business Mailing Address
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Address Line | 104 BAYARD ST SUITE 1
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-2102
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Country | US
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Telephone | 917-806-9662
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ISAAC GLASMAN
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Credential |
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Telephone | 817-806-9662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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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