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General NPI Number Information
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NPI Number | 1083074835
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Entity Type | Organization
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Legal Business Name | THE SHORES TREATMENT AND RECOVERY SERVICE, LLC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 8493 S US HIGHWAY 1 SUITE 14
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3360
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Country | US
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Telephone | 772-800-3990
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Fax |
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Provider Business Mailing Address
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Address Line | 8493 S US HIGHWAY 1 SUITE 14
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-3360
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | LAUREN HAUN
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Credential |
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Telephone | 772-800-3990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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