=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831366244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVERY INSTITUTE FOR ADDICTIVE DISORDERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 05/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 80 CONOVER RD
-----------------------------------------------------
City | MARLBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07746-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-946-9444
-----------------------------------------------------
Fax | 732-946-0758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 177
-----------------------------------------------------
City | MARLBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07746-0177
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-946-9444
-----------------------------------------------------
Fax | 732-946-0758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | ROBERT C DENES
-----------------------------------------------------
Credential | M.P.A., C.S.W.
-----------------------------------------------------
Telephone | 732-946-9444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 1000051
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------