College Recovery LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

COLLEGE RECOVERY LLC

Doing business as

SOBA New Jersey

Practice address

104 Bayard St
New Brunswick, NJ 08901-2389

Phone

(973) 556-7701

NPI assigned

Aug 7, 2024

Organization subpart

Yes

Parent organization

COLLEGE RECOVERY LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Isaac Glasman

Title

Director

Phone

(973) 556-7701

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• SOBA New Jersey Doing business as

Tax ID family

College Recovery LLC3 organizations share this tax ID, including this one

Part of

College Recovery LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• College Recovery LLC

  • Clinical Medical Laboratory
  • New Brunswick, NJ
  • NPI 1376996009
  NPD tax ID
• College Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • New Brunswick, NJ
  • NPI 1467852798
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1114757739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 BAYARD ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089012389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 BAYARD ST",
            "city": "NEW BRUNSWICK",
            "state": "NJ",
            "postal_code": "089012389",
            "telephone_number": "973-556-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEGE RECOVERY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLEGE RECOVERY LLC",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "GLASMAN",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "973-556-7701"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOH CN&L",
            "identifier": "2000540",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOBA New Jersey",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Parker Cole
• Peter D Cole, MD
• Andrew Joseph Colgan Jr., MD
• Michele Colin
• Tracy Colin, RD
• College Recovery LLC
• College Recovery LLC
• Dylan Collier, PA-C
• Christine Anne Collins
• Valerie Collins, MD

• Substance Use Disorder Rehabilitation Clinic/Center in New Brunswick, NJ
• Providers in New Brunswick, NJ by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.