# SOUTHGATE RESIDENTIAL LIFE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699002865
- **Authorized official:** MR. LAWRENCE DAVIS (MEMBER)
- **Authorized official phone:** (609) 288-6398

## Contact information

- **Practice address:** 2630 ROUTE 206, MOUNT HOLLY, NJ 08060-6708
- **Practice address phone:** (609) 288-6398
- **Mailing address:** 2630 ROUTE 206, MOUNT HOLLY, NJ 08060-6708
- **Mailing address phone:** (609) 288-6398

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 11/10/2009
- **Last updated:** 11/10/2009