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General NPI Number Information
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NPI Number | 1750962445
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Entity Type | Organization
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Legal Business Name | SOPHROS RECOVERY LLC
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/20/2021
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Provider Practice Location Address
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Address Line | 2511 SAINT JOHNS BLUFF RD S STE 105&106
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City | JACKSONVILLE
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State | FL
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Zip | 32246-2346
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Country | US
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Telephone | 808-388-3916
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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 105&106
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City | JACKSONVILLE
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State | FL
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Zip | 32246-2346
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Country | US
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Telephone | 808-388-3916
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NICHOLAS PADLO
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Credential |
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 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 #3
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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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