Provider Demographics
NPI:1992232029
Name:RECOVERY CENTERS OF AMERICA AT VOORHEES NJ MEDICAID ONLY
Entity type:Organization
Organization Name:RECOVERY CENTERS OF AMERICA AT VOORHEES NJ MEDICAID ONLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR, PATIENT ACCOUNT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLIHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-994-2968
Mailing Address - Street 1:2701 RENAISSANCE BLVD
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406
Mailing Address - Country:US
Mailing Address - Phone:610-994-2968
Mailing Address - Fax:
Practice Address - Street 1:2701 RENAISSANCE BLVD FL 4
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2781
Practice Address - Country:US
Practice Address - Phone:610-994-2968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRC-OC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-19
Last Update Date:2019-02-04
Deactivation Date:2018-05-09
Deactivation Code:
Reactivation Date:2019-02-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder