1609386135 NPI number — PINNACLE TREATMENT CENTERS NJ III LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609386135 NPI number — PINNACLE TREATMENT CENTERS NJ III LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINNACLE TREATMENT CENTERS NJ III LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609386135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 ROUTE 73
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-533-8762
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 W SHERMAN AVE BLDG 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-6931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-839-2210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TANIS
Authorized Official First Name:
ROBYN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIR CONTRACT MGMT
Authorized Official Telephone Number:
856-533-8762

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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