Provider Demographics
NPI:1013735851
Name:BLUE STAR RECOVERY
Entity type:Organization
Organization Name:BLUE STAR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-955-6507
Mailing Address - Street 1:72 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2534
Mailing Address - Country:US
Mailing Address - Phone:718-737-1547
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD STE 43AND47
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:718-737-1547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility