Organization
KINGSWAY RECOVERY LLC
Active
Organization
KINGSWAY RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS DESIMONE LCADC (FOUNDER/CEO)
(856) 217-9182
Entity
Organization
Contact information
Practice address
124 BRIDGETON PIKE, MULLICA HILL, NJ 08062
(856) 217-9182
Mailing address
124 BRIDGETON PIKE, MULLICA HILL, NJ 08062-2670
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
09/08/2017
Last updated
09/21/2018
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