LOST SOULS RECOVERY, LLC (NPI# 1386160448) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386160448 |
| Entity Type | Organization |
| Organization Name | LOST SOULS RECOVERY, LLC |
| Other Organization Name | LOST SOULS RECOVERY , LLC |
| Practice Address |
130 White Horse Pike Clementon NJ 08021-4159 |
| Practice Telephone | 8563442003 |
| Mailing Telephone | 8563442003 |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2019-05-07 |
| Authorized Official Name | MR. ALEXANDER OTT (ADMINISTRATOR) |
| Authorized Official Telephone | 8563442003 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Lost Souls Recovery , LLC | Doing Business As Name - Organization |
| LSR | Doing Business As Name - Organization |
| Street Address |
130 WHITE HORSE PIKE |
| City | CLEMENTON |
| State | NJ |
| Zip Code | 08021-4159 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366414799 | David Gary Krefetz | Psychiatry & Neurology | 130 White Horse Pike, Clementon, NJ 08021-4159 | 2006-02-01 |
| 1134608441 | Tara Marie Mastroianni | Counselor | 130 White Horse Pike, Clementon, NJ 08021-4159 | 2018-08-08 |
| 1457533671 | Karen Eve Locker | Social Worker | 130 White Horse Pike, Clementon, NJ 08021-4159 | 2007-11-29 |
| 1891915427 | Howard Hassman | Family Medicine | 130 White Horse Pike, Clementon, NJ 08021-4159 | 2007-04-26 |
| 1841410487 | Barbara Kelly | Psychologist | 130 White Horse Pike, Clementon, NJ 08021-4159 | 2007-04-26 |
| 1659599918 | Steven Jeromeg Glass | Psychiatry & Neurology | 130 White Horse Pike, Clementon, NJ 08021-4159 | 2007-04-23 |
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| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.