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General NPI Number Information
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NPI Number | 1417386624
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Entity Type | Organization
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Legal Business Name | OCEAN ADDICTION RECOVERY SERVICES, LLC
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 1705 19 PL STE E-2
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City | VERO BEACH
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State | FL
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Zip | 32960
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Country | US
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Telephone | 772-257-5995
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Fax | 772-257-5995
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Provider Business Mailing Address
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Address Line | 1705 19TH PL STE E-2
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City | VERO BEACH
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State | FL
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Zip | 32960-0686
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Country | US
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Telephone | 772-257-5995
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Fax | 772-257-5995
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS WADE MORELAND
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Credential | DO
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Telephone | 772-257-5995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number | 0S10340
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License Number State | FL
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