Provider Demographics
NPI:1083074835
Name:THE SHORES TREATMENT AND RECOVERY SERVICE, LLC
Entity Type:Organization
Organization Name:THE SHORES TREATMENT AND RECOVERY SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-800-3990
Mailing Address - Street 1:8493 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8493 S US HIGHWAY 1
Practice Address - Street 2:SUITE 14
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3360
Practice Address - Country:US
Practice Address - Phone:772-800-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty