Provider Demographics
NPI:1720363195
Name:BEACHCOMBER RETREAT, LLC
Entity Type:Organization
Organization Name:BEACHCOMBER RETREAT, LLC
Other - Org Name:BRIDGING THE GAP RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:MURPHREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-249-4300
Mailing Address - Street 1:220 S HIGHWAY 79
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-2151
Mailing Address - Country:US
Mailing Address - Phone:850-249-4300
Mailing Address - Fax:850-640-1174
Practice Address - Street 1:220 S HIGHWAY 79
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-2151
Practice Address - Country:US
Practice Address - Phone:850-249-4300
Practice Address - Fax:850-640-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X, 324500000X
FL101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty