Organization
SHORE BREAK RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN KOCH LCADC (CEO)
(609) 709-0244
Entity
Organization
Contact information
Practice address
6 CHESTNUT ST UNIT 9, SOMERS POINT, NJ 08244-1125
(609) 709-0244
Mailing address
211 E SEAVIEW AVE, LINWOOD, NJ 08221-2139
(609) 709-0244
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/26/2021
Last updated
10/23/2025
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