Provider Demographics
NPI:1265004576
Name:BRIDGE TO SHORE RECOVERY, LLC
Entity Type:Organization
Organization Name:BRIDGE TO SHORE RECOVERY, LLC
Other - Org Name:THE AUGUSTINE RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMISSIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-217-0480
Mailing Address - Street 1:3930 US 1 S
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7089
Mailing Address - Country:US
Mailing Address - Phone:904-217-0480
Mailing Address - Fax:904-217-3081
Practice Address - Street 1:3 DAVIS ST
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-0476
Practice Address - Country:US
Practice Address - Phone:042-170-4809
Practice Address - Fax:904-217-3081
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE AUGUSTINE RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-15
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME38055OtherMD
FLMH17663OtherLMHC
FLSW16603OtherLCSW
FLAPRN2520572OtherAPRN