Provider Demographics
NPI:1740578830
Name:OCEANSIDE RECOVERY LLC
Entity Type:Organization
Organization Name:OCEANSIDE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-324-9313
Mailing Address - Street 1:23 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1621
Mailing Address - Country:US
Mailing Address - Phone:860-691-0873
Mailing Address - Fax:860-691-0876
Practice Address - Street 1:23 CHURCH LN
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1621
Practice Address - Country:US
Practice Address - Phone:860-691-0873
Practice Address - Fax:860-691-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003399363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty