Stanford Ctc Services, LLC
Substance Abuse Rehabilitation Facility in Blackwood, NJ. Organization (NPI-2).
NPI number1699247635
StatusActive
Last updated in NPPESSep 18, 2020
Details
- NPI
- 1699247635
- Entity type
- Organization (NPI-2)
- Legal business name
- Stanford Ctc Services, LLC
- Organization subpart
- No
- Enumeration date
- Dec 31, 2018
- Certification date
- Sep 18, 2020
- Last updated
- Sep 18, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | – | – | Yes |
| 261QM0855X | Clinic/Center, Adolescent and Children Mental Health | – | – |
Practice location
141 S Black Horse Pike Ste 204Blackwood, NJ 08012-2975
Phone 856-302-6437 · Fax 856-302-5532
Mailing address
24 Patricia LnSicklerville, NJ 08081-1810
Phone 856-728-6029 · Fax 856-302-5532
Authorized official
Leroy Stanford
Ceo
8563026437
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