Provider Demographics
NPI:1306629761
Name:SOPHROS RECOVERY TAMPA LLC
Entity type:Organization
Organization Name:SOPHROS RECOVERY TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMERER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-388-3916
Mailing Address - Street 1:2511 SAINT JOHNS BLUFF RD S STE 106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-2344
Mailing Address - Country:US
Mailing Address - Phone:904-440-1479
Mailing Address - Fax:
Practice Address - Street 1:10500 UNIVERSITY CENTER DR STE 215
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6490
Practice Address - Country:US
Practice Address - Phone:904-440-1479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOPHROS RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility