Provider Demographics
NPI:1417386624
Name:OCEAN ADDICTION RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:OCEAN ADDICTION RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-257-5995
Mailing Address - Street 1:1705 19TH PL
Mailing Address - Street 2:STE E-2
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0686
Mailing Address - Country:US
Mailing Address - Phone:772-257-5995
Mailing Address - Fax:772-257-5995
Practice Address - Street 1:1705 19 PL
Practice Address - Street 2:STE E-2
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-257-5995
Practice Address - Fax:772-257-5995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S10340207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G53749Medicare UPIN