Provider Demographics
NPI:1073907937
Name:BEACHES RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:BEACHES RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DARCY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAP
Authorized Official - Phone:575-779-2456
Mailing Address - Street 1:75 12TH ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3422
Mailing Address - Country:US
Mailing Address - Phone:904-685-9083
Mailing Address - Fax:
Practice Address - Street 1:75 12TH ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3422
Practice Address - Country:US
Practice Address - Phone:904-685-9083
Practice Address - Fax:904-485-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty