Basic Information
| Provider Information | |||||||||
| NPI: | 1528563897 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSSROADS TREATMENT CENTERS OF NEW JERSEY, PC | ||||||||
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| OtherOrganizationName: | CROSSROADS TREATMENT CENTER OF TOMS RIVER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 BEATTIE PL STE 810 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645273145 | ||||||||
| FaxNumber: | 8649900653 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 ROUTE 37 W | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087555032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8482244578 | ||||||||
| FaxNumber: | 8482244276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTS SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8645273145 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CROSSROADS TREATMENT CENTER OF TOMS RIVER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NJ | N | Agencies | Community/Behavioral Health | 261QM2800X | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Methadone Clinic |
No ID Information.