Provider Demographics
NPI:1154868388
Name:OCEAN SPIRIT RECOVERY
Entity Type:Organization
Organization Name:OCEAN SPIRIT RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-933-1874
Mailing Address - Street 1:2701 E ATLANTIC BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4941
Mailing Address - Country:US
Mailing Address - Phone:954-933-1874
Mailing Address - Fax:
Practice Address - Street 1:1301 N OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3449
Practice Address - Country:US
Practice Address - Phone:954-933-1874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility