Provider Demographics
NPI:1295127900
Name:OCEAN ADDICTION RECOVERY SERVICES
Entity type:Organization
Organization Name:OCEAN ADDICTION RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:IACULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-404-5872
Mailing Address - Street 1:1705 19TH PL STE E2
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0688
Mailing Address - Country:US
Mailing Address - Phone:561-404-5872
Mailing Address - Fax:
Practice Address - Street 1:1705 19TH PL STE E2
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-0688
Practice Address - Country:US
Practice Address - Phone:561-404-5872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1931AD043001324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility