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General NPI Number Information
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NPI Number | 1265004576
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Entity Type | Organization
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Legal Business Name | BRIDGE TO SHORE RECOVERY, LLC
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 3 DAVIS ST
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-0476
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Country | US
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Telephone | 42-170-4809
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Fax | 904-217-3081
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Provider Business Mailing Address
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Address Line | 3930 US 1 S
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-7089
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Country | US
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Telephone | 904-217-0480
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Fax | 904-217-3081
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Authorized Official
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Title or Position | ADMISSIONS SUPERVISOR
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Name | PHILLIP D SNYDER
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Credential |
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Telephone | 904-217-0480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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