Provider Demographics
NPI:1063308864
Name:MILESTONE TREATMENT CENTER LLC
Entity type:Organization
Organization Name:MILESTONE TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-449-6159
Mailing Address - Street 1:1101 LASKIN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-5209
Mailing Address - Country:US
Mailing Address - Phone:856-406-2829
Mailing Address - Fax:
Practice Address - Street 1:1101 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-5209
Practice Address - Country:US
Practice Address - Phone:856-406-2829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility