Southgate Residential Life Center

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

SOUTHGATE RESIDENTIAL LIFE CENTER

Practice address

2630 Route 206
Mount Holly, NJ 08060-6708

Phone

(609) 288-6398

NPI assigned

Nov 10, 2009

Last updated

Nov 10, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Lawrence Davis

Title

Member

Phone

(609) 288-6398

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1257811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257811200000",
    "number": "1699002865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630 ROUTE 206",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080606708",
            "telephone_number": "609-288-6398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 ROUTE 206",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080606708",
            "telephone_number": "609-288-6398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGATE RESIDENTIAL LIFE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-10",
        "last_updated": "2009-11-10",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "609-288-6398",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL",
            "identifier": "1700049475",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1946510",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Solutions for U
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• Gail Marie Spinnato, LCSW
• Frederic Steinberg, DO
• Kathleen Steinberg, CRNA
• Amanda Stevenson
• Kirk Stevenson

• Emotionally Disturbed Childrens' Residential Treatment Facility in Mount Holly, NJ
• Providers in Mount Holly, NJ by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2009; 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.