Healthcare Provider Details

I. General information

NPI: 1306609854
Provider Name (Legal Business Name): STARTING POINTE RECOVERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH AVE E STE 2
BRADENTON FL
34208-1043
US

IV. Provider business mailing address

201 4TH AVE E STE 2
BRADENTON FL
34208-1043
US

V. Phone/Fax

Practice location:
  • Phone: 941-226-0018
  • Fax: 941-260-4872
Mailing address:
  • Phone: 941-226-0018
  • Fax: 941-260-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TINA MARIE JACKSON
Title or Position: PRESIDENT/CEO
Credential: RN
Phone: 517-410-6164