ST JOHN'S RECOVERY PLACE LLC (NPI# 1144839283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144839283 |
| Entity Type | Organization |
| Organization Name | ST JOHN'S RECOVERY PLACE LLC |
| Practice Address |
St Johns Recovery Place LLC 1811 S Orlando Ave Cocoa Beach FL 32931-3211 |
| Mailing Address |
St Johns Recovery Place LLC 1125 N Summit Street Crescent City FL 32112 |
| Practice Telephone | 9549452984 |
| Mailing Telephone | 9549452984 |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2020-07-24 |
| Authorized Official Name | SHANNON MICHELLE SMITH (CHIEF OPERATIONS OFFICER) |
| Authorized Official Telephone | 9549452984 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215429436 | St John's Recovery Place LLC | Substance Abuse Rehabilitation Facility | 1125 N Summit St, Crescent City, FL 32112-1721 | 2018-06-04 |
| 1184223406 | St John's Recovery Place LLC | Clinic/Center | 1045 Williamsburg Rd, Deland, FL 32720-1449 | 2020-10-19 |
| Street Address |
ST JOHNS RECOVERY PLACE LLC 1811 S ORLANDO AVE |
| City | COCOA BEACH |
| State | FL |
| Zip Code | 32931-3211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699275016 | Daniel Edgar Ferrier | Specialist/Technologist | 741 S Orlando Ave Apt B, Cocoa Beach, FL 32931 | 2018-02-13 |
| 1891206793 | Peace Club Inc. | Counselor | 1811 S. Orlando Avenue, Cocoa Beach, FL 32931 | 2017-10-18 |
| 1811384696 | Magnolia House Assisted Living Facility LLC | Assisted Living Facility | 103 Yacht Haven Drive, Cocoa Beach, FL 32931 | 2015-04-20 |
| 1801236807 | Muhammad Ishfaq | Internal Medicine | 701 W Cocoa Beach Causeway, Cocoa Beach, FL 32931 | 2013-07-05 |
| 1053658799 | Charles King | Pharmacist | 2067 North Atlantic Ave, Cocoa Beach, FL 32931 | 2013-01-15 |
| 1033464441 | Cori Megan Daniels | Nurse Practitioner | 1980 N. Atlantic Ave, Suite 627, Cocoa Beach, FL 32931 | 2012-07-23 |
| 1871850313 | Adel Tadros Fahmy | Obstetrics & Gynecology | 68 Country Club Road, Cocoa Beach, FL 32931 | 2012-04-23 |
| 1497021760 | Armstrong Chiropractic Family Center, Inc. | Clinic/Center | 1401 N. Atlantic Ave., Cocoa Beach, FL 32931 | 2012-03-30 |
| 1710261516 | Jill L Carey | Speech-Language Pathologist | 50 Country Club Rd, Cocoa Beach, FL 32931 | 2011-09-28 |
| 1700173416 | Barbara Greene | Registered Nurse | 26 West Point Drive, Cocoa Beach, FL 32931 | 2011-07-01 |
| Find all providers in zip 32931 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | COCOA BEACH |
| Zip Code | 32931 |
Please comment or provide details below to improve the information on ST JOHN'S RECOVERY PLACE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.