Basic Information
| Provider Information | |||||||||
| NPI: | 1386888279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HABIT OPCO, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CENTRAL JERSEY COMPREHENSIVE TREATMENT CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6185 PASEO DEL NORTE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920111155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552592288 | ||||||||
| FaxNumber: | 2609308923 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 HIGHWAY 35 | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | CLIFFWOOD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077211515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327272555 | ||||||||
| FaxNumber: | 7377270255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2009 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | SANDERSON | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, CTC DIVISION | ||||||||
| AuthorizedOfficialTelephone: | 8552592288 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 2000337 | NJ | N | Ambulatory Health Care Facilities | Clinic/Center | 261QM2800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
ID Information
| ID | Type | State | Issuer | Description | 0191256 | 05 | NJ | MEDICAID |