NPIMap

Organization Active NPI

Lost Souls Recovery, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Clementon, NJ
National Provider Identifier
1386160448
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
LOST SOULS RECOVERY, LLC
Practice address
130 White Horse Pike
Clementon, NJ 08021-4159
Phone
(856) 344-2003
NPI assigned
Aug 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Authorized official

Name
Mr. Alexander Ott, LMFT
Title
Administrator
Phone
(856) 344-2003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

130 White Horse Pike
Clementon, NJ 08021-4159

Mailing address

130 White Horse Pike
Clementon, NJ 08021-4159
Phone (856) 344-2003

Other names 1

  • Lost Souls Recovery , LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210616000045 NJ Part B Supplier - Clinic/Group Practice 2860892627 Receives reassigned benefits from 5 practitioners
Practice locations: Clementon, NJ

National Provider Directory

National Provider Directory

Locations

130 White Horse Pike
Clementon, NJ 08021
Phone (570) 622-9101

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1503187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557187200000",
    "number": "1386160448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 WHITE HORSE PIKE",
            "city": "CLEMENTON",
            "state": "NJ",
            "postal_code": "080214159",
            "telephone_number": "856-344-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 WHITE HORSE PIKE",
            "city": "CLEMENTON",
            "state": "NJ",
            "postal_code": "080214159",
            "telephone_number": "856-344-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOST SOULS RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-20",
        "last_updated": "2019-05-07",
        "status": "A",
        "authorized_official_last_name": "OTT",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "856-344-2003",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lost Souls Recovery , LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clementon, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; 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.