Provider Demographics
NPI:1770051484
Name:OVERCOME WELLNESS & RECOVERY
Entity type:Organization
Organization Name:OVERCOME WELLNESS & RECOVERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-505-7633
Mailing Address - Street 1:205 W PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5105
Mailing Address - Country:US
Mailing Address - Phone:732-505-7633
Mailing Address - Fax:
Practice Address - Street 1:101 PROSPECT ST STE 210
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5003
Practice Address - Country:US
Practice Address - Phone:732-505-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2000913OtherSTATE OF N E W JERSEY DEPARTMENT OF HEALTH DIVISION OF CERTIFICATE OF NEED& LICE