Provider Demographics
NPI:1336973916
Name:RECOVERY CENTER OF SOUTH JERSEY
Entity type:Organization
Organization Name:RECOVERY CENTER OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOMOH
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-496-3641
Mailing Address - Street 1:20 MEDFORD LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3121
Mailing Address - Country:US
Mailing Address - Phone:856-496-3641
Mailing Address - Fax:
Practice Address - Street 1:20 MEDFORD LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3121
Practice Address - Country:US
Practice Address - Phone:856-496-3641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder