Provider Demographics
NPI:1619356888
Name:THE SHORES TREATMENT AND RECOVERY
Entity Type:Organization
Organization Name:THE SHORES TREATMENT AND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VECCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-800-3990
Mailing Address - Street 1:8493 S US HIGHWAY 1 STE 14
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT 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 STE 14
Practice Address - Street 2:
Practice Address - City:PORT SAINT 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:2015-05-21
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty