Provider Demographics
NPI:1659051647
Name:SHORELINE MEDICAL ADDICTION TREATMENT LLC
Entity Type:Organization
Organization Name:SHORELINE MEDICAL ADDICTION TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:VIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-339-6808
Mailing Address - Street 1:107 EAST CIR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-5213
Mailing Address - Country:US
Mailing Address - Phone:850-339-6808
Mailing Address - Fax:
Practice Address - Street 1:602 W INDIAN RIVER BLVD STE 2
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-3500
Practice Address - Country:US
Practice Address - Phone:386-868-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder