Provider Demographics
NPI:1326485475
Name:SHORES TREATMENT AND RECOVERY SERVICE LLC
Entity Type:Organization
Organization Name:SHORES TREATMENT AND RECOVERY SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-797-9977
Mailing Address - Street 1:8493 S US HIGHWAY 1
Mailing Address - Street 2:UNIT 14
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-3360
Mailing Address - Country:US
Mailing Address - Phone:626-797-9977
Mailing Address - Fax:626-844-2977
Practice Address - Street 1:8493 S US HIGHWAY 1
Practice Address - Street 2:UNIT 14
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3360
Practice Address - Country:US
Practice Address - Phone:626-797-9977
Practice Address - Fax:626-844-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children