Stanford CTC Services, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

STANFORD CTC SERVICES, LLC

Practice address

141 S Black Horse Pike Ste 204
Blackwood, NJ 08012-2975

Phone

(856) 302-6437

Fax

(856) 302-5532

NPI assigned

Dec 31, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Leroy Stanford Jr., LCADCNPI 1013395052

Title

Ceo

Phone

(856) 302-6437

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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

• Leroy Stanford Jr.

  • Addiction (Substance Use Disorder) Counselor
  • Camden, NJ
  • NPI 1013395052
  NPD Authorized official
• Destiny Hill, MS, LAC, LCADC

  • Professional Counselor
  • Blackwood, NJ
  • NPI 1831747393
  NPD (past)

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

{
    "created_epoch": "1546214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1699247635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 PATRICIA LN",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811810",
            "telephone_number": "856-728-6029",
            "fax_number": "856-302-5532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 S BLACK HORSE PIKE STE 204",
            "city": "BLACKWOOD",
            "state": "NJ",
            "postal_code": "080122975",
            "telephone_number": "856-302-6437",
            "fax_number": "856-302-5532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANFORD CTC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-31",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A",
        "authorized_official_last_name": "STANFORD",
        "authorized_official_first_name": "LEROY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "856-302-6437",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LCADC"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Jersey Medical Associates, P.a.
• South Jersey Nurse Practitioners Services
• South Jersey Phlebotomy Services, LLC
• Rebecca Sparks, OTR/L
• Margaret Stachowski, ANP
• Scott Strahle, G.N.P.
• Andrea Stumpo, RD
• Iryna V Talerico, DPT
• Karla Taliadouros, RDN,CDCES,LDN
• Audrey Taormina, LPC

• Substance Abuse Rehabilitation Facility in Blackwood, NJ
• Providers in Blackwood, NJ by specialty
• Substance Abuse Rehabilitation Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; 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.