| Organization Name: | 5034 ATLANTIC AVE OPCO, LLC |
| NPI Number: | 1528433356 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARDONNAY DI NENNA (DIRECTOR OF COMPLIANCE AND QUALITY) |
| Mailing Address: | 5034 Atlantic Ave Mays Landing |
| State: | NJ US |
| Postal Code: | 083302022 |
| Phone Number: | 6104914475 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2015 |
| NPI Last Update Date: | 12/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 324500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |