Coral Bay Recovery LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

CORAL BAY RECOVERY LLC

Practice address

3170 N Federal Hwy Ste 206E
Lighthouse Point, FL 33064-6720

Phone

(754) 444-1458

NPI assigned

Apr 5, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Jacobson, LMFT, MCAPNPI 1841643178

Title

Ceo

Phone

(954) 552-5100

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Jacobson, LMFT, MCAP

  • Addiction (Substance Use Disorder) Counselor
  • Lighthouse Point, FL
  • NPI 1841643178
  NPD Authorized official
• Sharon Paulette Johnson Hyatt

  • Psychiatric/Mental Health Nurse Practitioner
  • Miramar, FL
  • NPI 1396210555
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737417600000",
    "number": "1003313131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3170 N FEDERAL HWY STE 204A",
            "city": "LIGHTHOUSE POINT",
            "state": "FL",
            "postal_code": "330646736",
            "telephone_number": "954-552-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3170 N FEDERAL HWY STE 206E",
            "city": "LIGHTHOUSE POINT",
            "state": "FL",
            "postal_code": "330646720",
            "telephone_number": "754-444-1458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAL BAY RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-05",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-552-5100",
        "authorized_official_credential": "LMFT, MCAP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John A. Chonka, AUD
• City of Lighthouse Point
• Cheyenne Clarke
• Willisa P Clarke, PHARMD
• Adam Christopher Colavito, D.C.
• Tiffany Shawnakay Costley, ARNP
• Maureen M Crissy, RN, IBCLC
• Maria Mercedes Cristancho, M.D
• Megan Lynn Cronauer, ARNP
• Allin Bland Crouch Jr., D.D.S.

• Substance Use Disorder Rehabilitation Clinic/Center in Lighthouse Point, FL
• Providers in Lighthouse Point, FL by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.