Organization
PACIFIC LIGHT RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALVATORE J. JOHNSON (CEO)
(917) 250-9323
Entity
Organization
Contact information
Practice address
811 CHURCH RD, CHERRY HILL, NJ 08002-1412
(917) 250-9323
Mailing address
304 ARCADIA CT, JACKSON, NJ 08527-2296
(917) 250-9323
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/26/2018
Last updated
04/26/2018
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