Provider Demographics
NPI:1699247635
Name:STANFORD CTC SERVICES, LLC
Entity type:Organization
Organization Name:STANFORD CTC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCADC
Authorized Official - Phone:856-302-6437
Mailing Address - Street 1:24 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1810
Mailing Address - Country:US
Mailing Address - Phone:856-728-6029
Mailing Address - Fax:856-302-5532
Practice Address - Street 1:141 S BLACK HORSE PIKE STE 204
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2975
Practice Address - Country:US
Practice Address - Phone:856-302-6437
Practice Address - Fax:856-302-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-31
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health