Pacific Light Recovery Center

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PACIFIC LIGHT RECOVERY CENTER

Practice address

811 Church Rd
Cherry Hill, NJ 08002-1412

Phone

(917) 250-9323

NPI assigned

Apr 26, 2018

Organization subpart

No

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

Authorized official

Name

Salvatore J. Johnson

Title

Ceo

Phone

(917) 250-9323

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1295223147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 ARCADIA CT",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085272296",
            "telephone_number": "917-250-9323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 CHURCH RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080021412",
            "telephone_number": "917-250-9323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC LIGHT RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-26",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "SALVATORE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "917-250-9323"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Pacheco
• Arvin Pacis
• Kaltrina Pacuku
• Katlyn Pagaduan
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• Abigail A Pagano, PT, DPT

• Substance Use Disorder Rehabilitation Clinic/Center in Cherry Hill, NJ
• Providers in Cherry Hill, 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 Apr 26, 2018; 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.