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General NPI Number Information
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NPI Number | 1306629761
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Entity Type | Organization
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Legal Business Name | SOPHROS RECOVERY TAMPA LLC
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 10500 UNIVERSITY CENTER DR STE 215
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City | TAMPA
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State | FL
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Zip | 33612-6490
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Country | US
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Telephone | 904-440-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 2511 SAINT JOHNS BLUFF RD S STE 106
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City | JACKSONVILLE
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State | FL
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Zip | 32246-2344
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Country | US
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Telephone | 904-440-1479
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN KEMERER
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Credential | DO
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Telephone | 808-388-3916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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