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Southgate Residential Life Center
Emotionally Disturbed Childrens' Residential Treatment Facility in Mount Holly, New Jersey
NPI 1699002865

Southgate Residential Life Center is a Emotionally Disturbed Childrens' Residential Treatment Facility based in Mount Holly, NJ. Southgate Residential Life Center practices in Mount Holly, NJ. The NPI Number for Southgate Residential Life Center is 1699002865 and holds a License No. (New Jersey).

The current practice location address for Southgate Residential Life Center is 2630 Route 206, Mount Holly, NJ and can be reached out via phone at 609-288-6398.

Location: 2630 Route 206, Mount Holly, NJ, 08060-6708
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1699002865
Provider Name
Southgate Residential Life Center
Credential
Provider Entity Type
Organization
Address
2630 Route 206, Mount Holly, NJ, 08060-6708
Phone Number
609-288-6398
Fax Number
Provider Enumeration Date
11/10/2009
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1700049475 01 NJ INDIVIDUAL
1946510 05 NJ
institution
Provider Business Practice Location Address Details
Address
2630 Route 206
City
Mount Holly
State
New Jersey
Zip
08060-6708
Phone Number
609-288-6398
Fax Number
person
Provider Business Mailing Address Details
Address
2630 Route 206
City
Mount Holly
State
New Jersey
Zip
08060-6708
Phone Number
609-288-6398
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Residential Treatment Facility, Emotionally Disturbed Children
Speciality
-
Taxonomy
322D00000X
License No.
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Definition
A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
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