SOUTHGATE RESIDENTIAL LIFE CENTER (NPI# 1699002865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699002865 |
| Entity Type | Organization |
| Organization Name | SOUTHGATE RESIDENTIAL LIFE CENTER |
| Practice Address |
2630 Route 206 Mount Holly NJ 08060-6708 |
| Practice Telephone | 6092886398 |
| Mailing Telephone | 6092886398 |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2009-11-10 |
| Authorized Official Name | MR. LAWRENCE DAVIS (MEMBER) |
| Authorized Official Telephone | 6092886398 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NJ | INDIVIDUAL | 1700049475 | 01 |
| NJ | 1946510 | 05 |
| Street Address |
2630 ROUTE 206 |
| City | MOUNT HOLLY |
| State | NJ |
| Zip Code | 08060-6708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821613092 | Priscilla Gonzales | Counselor | 795 Woodlane Road, Suite 301, Mount Holly, NJ 08060 | 2020-06-12 |
| 1255838157 | Frederick Hart IIi | Occupational Therapist | 1934 Burlington-mt. Holly Road Suite A, Westampton, NJ 08060 | 2018-04-09 |
| 1457860116 | Lea Gartenmayer | Speech-Language Pathologist | 1934 Burlington-mount Holly Rd, Westampton, NJ 08060 | 2017-09-26 |
| 1295261618 | Bancroft Neurohealth | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 202 Burrs Rd, Westampton, NJ 08060 | 2017-05-04 |
| 1871038620 | Michael Green. | Counselor | 770 Wooland Road, Westampton, NJ 08060 | 2017-01-04 |
| 1851841696 | Virtua Medical Group, Pa | Clinic/Center | 555 High St, Suite 16a, Mount Holly, NJ 08060 | 2016-10-05 |
| 1821441213 | Joseph Cooper Sr. | Counselor | 770 Woodlene Road, Westampton, NJ 08060 | 2016-07-20 |
| 1790148724 | Leah Holden | Pharmacist | 531 High St, Mt Holly, NJ 08060 | 2016-03-29 |
| 1083088892 | Joanne Hawkins | Counselor | 770 Woodlane Rd. Suite 35, Mt. Holly, NJ 08060 | 2015-11-17 |
| 1730557448 | Legacy Treatment Services | In Home Supportive Care | 243 Pine Street, Mount Holly, NJ 08060 | 2015-09-11 |
| Find all providers in zip 08060 | ||||
| Taxonomy Code | 322D00000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Emotionally Disturbed Children |
| A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment. |
| Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851550990 | Union Association of The Childrens Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 248 Pine St, Mount Holly, NJ 08060-2207 | 2008-06-04 |
| 1710397799 | Union Association of The Children's Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2014-04-30 |
| 1891047072 | Union Association of The Children's Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2012-10-11 |
| 1265691893 | Union Association of The Children's Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2008-06-09 |
| 1992964027 | Union Association of The Childrens Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2008-06-04 |
| 1619136744 | Union Association of The Childrens Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2008-06-04 |
| 1336308477 | Union Association of The Childrens Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2008-06-04 |
| 1962661009 | Union Association of The Childrens Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2008-06-04 |
| 1972622199 | Union Association of The Children's Home of Burlington County | Residential Treatment Facility, Emotionally Disturbed Children | 243 Pine St, Mount Holly, NJ 08060-2201 | 2007-03-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427519727 | Willowglen Academy - New Jersey. Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 357 Route 94, Newton, NJ 07860-5136 | 2019-03-28 |
| 1649731290 | Willowglen Academy - New Jersey. Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 22 Route 519, Newton, NJ 07860-6230 | 2019-03-27 |
| 1639656705 | Devereux Foundation | Residential Treatment Facility, Emotionally Disturbed Children | 124 Wertsville Rd, Hillsborough, NJ 08844-3908 | 2018-07-23 |
| 1164938049 | Saving Grace Ministries Inc | Residential Treatment Facility, Emotionally Disturbed Children | 436 Spruce St, Camden, NJ 08103-2032 | 2017-12-14 |
| 1790235539 | National Mentor Healthcare, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 8 Dugans Grv, Millstone Twp, NJ 08535-8014 | 2016-10-05 |
| 1619421104 | National Mentor Healthcare, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 201 Stillhouse Rd, Millstone Twp, NJ 08510-7967 | 2016-08-12 |
| 1396192886 | Ranch Hope Inc | Residential Treatment Facility, Emotionally Disturbed Children | 45 Sawmill Rd, Alloway, NJ 08001-1004 | 2016-05-16 |
| 1972972164 | National Mentor Healthcare, LLC | Residential Treatment Facility, Emotionally Disturbed Children | 509 Mine Road, Bethlehem Township, NJ 08802 | 2015-09-18 |
| 1548641459 | Allies, Inc. | Residential Treatment Facility, Emotionally Disturbed Children | 46 Featherbed Ln, Flemington, NJ 08822-5638 | 2015-06-16 |
| 1760891055 | Therapeutic Alternatives | Residential Treatment Facility, Emotionally Disturbed Children | 20 Hadley Ln, Suite 100, Willingboro, NJ 08046-1701 | 2014-08-12 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT HOLLY |
| Zip Code | 08060 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.