Kingsway Recovery LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

KINGSWAY RECOVERY LLC

Practice address

124 Bridgeton Pike
Mullica Hill, NJ 08062

Phone

(856) 217-9182

NPI assigned

Sep 8, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Nicholas Desimone, LCADCNPI 1346788676

Title

Founder/Ceo

Phone

(856) 217-9182

Specialties & licenses 3

Addresses

Locations

Practitioners 2

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

• Nicholas Desimone

  • Professional Counselor
  • Laurel Springs, NJ
  • NPI 1346788676

  Addiction (Substance Use Disorder)

  NPD Authorized official
• Jessica Hoofnagle, LPCMH, LPC, NCC

  • Professional Counselor
  • Wilmington, DE
  • NPI 1821627027

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1504828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537488000000",
    "number": "1639697782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 BRIDGETON PIKE",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080622670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 BRIDGETON PIKE",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "08062",
            "telephone_number": "856-217-9182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGSWAY RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-08",
        "last_updated": "2018-09-21",
        "status": "A",
        "authorized_official_last_name": "DESIMONE",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "FOUNDER/CEO",
        "authorized_official_telephone_number": "856-217-9182",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerald J Killoran, D.M.D.
• Elaine Kilmartin, M.D.
• Nataliia Kim
• Soo-Jung Kim
• Jared Kent Kimelheim
• Richard Klauber, APN-C
• Adina Coleman Kline, M.A. CCC-SLP
• Alison Marie Knowles
• Ko Skills Training & Therapy
• Manisha Koneru, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Mullica Hill, NJ
• Providers in Mullica 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 Sep 21, 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.