NPIMap

Organization Active NPI

Pinnacle Treatment Centers NJ-III, LLC

  • Methadone Clinic
  • Pennsauken, NJ
National Provider Identifier
1376712786
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
PINNACLE TREATMENT CENTERS NJ-III, LLC
Practice address
7980 S Crescent Boulevard
Pennsauken, NJ 08109
Phone
(856) 665-5100
Fax
(856) 665-5243
NPI assigned
Feb 29, 2008
Organization subpart
Yes
Parent organization
PINNACLE TREATMENT CENTERS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Authorized official

Name
Robyn Tanis
Title
Executive Director Contract MGMT
Phone
(856) 533-8762

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary
Recovery Care Clinic/Center 261QR0800X

Addresses

Primary practice location

7980 S Crescent Boulevard
Pennsauken, NJ 08109

Mailing address

1317 Route 73
Mount Laurel, NJ 08054-2202
Phone (856) 439-6111

Other names 1

  • Delaware Valley Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200131001378 NJ Part B Supplier - Opioid Treatment Program (Otp) 4284060799 5 other NPIs on this enrollment
Practice locations: Hamilton, NJ; Pennsauken, NJ; Somerdale, NJ; Trenton, NJ; Vineland, NJ

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pinnacle Trtmnt Ctr NJ III14 organizations share this tax ID, including this one
Part of
Pinnacle Treatment Centers Oh -Xvii

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1204243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1376712786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 ROUTE 73",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080542202",
            "telephone_number": "856-439-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7980 S CRESCENT BOULEVARD",
            "city": "PENNSAUKEN",
            "state": "NJ",
            "postal_code": "08109",
            "telephone_number": "856-665-5100",
            "fax_number": "856-665-5243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINNACLE TREATMENT CENTERS NJ-III, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINNACLE TREATMENT CENTERS INC",
        "enumeration_date": "2008-02-29",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "TANIS",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR CONTRACT MGMT",
        "authorized_official_telephone_number": "856-533-8762"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Recovery Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Delaware Valley Medical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Delaware Valley Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pennsauken, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.