Provider Demographics
NPI:1790308708
Name:JOHN BROOKS RECOVERY CENTER , A NEW JERSEY NONPROFIT CORPORATION
Entity type:Organization
Organization Name:JOHN BROOKS RECOVERY CENTER , A NEW JERSEY NONPROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PALLIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-345-2020
Mailing Address - Street 1:660 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-2360
Mailing Address - Country:US
Mailing Address - Phone:609-345-2020
Mailing Address - Fax:
Practice Address - Street 1:1455 PINEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-345-2020
Practice Address - Fax:609-646-7027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility