NPIMap

Organization Active NPI

Beaded Star Recovery,LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jacksonville Beach, FL
National Provider Identifier
1053681205
Registry record updated Aug 7, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
ND546 Issued in FL
Legal business name
BEADED STAR RECOVERY,LLC
Practice address
2380 3Rd St S
Suite 1
Jacksonville Beach, FL 32250-4023
Phone
(904) 241-3113
Fax
(904) 513-9268
NPI assigned
Jan 5, 2012
Last updated
Aug 7, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2015

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

Authorized official

Name
Ms. Marilyn K Dahl, RD, LD/N, MBA, CEDRD
Title
Owner
Phone
(904) 241-3113

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X ND546 FL Primary
Mental Health Counselor 101YM0800X MH8334 FL
Registered Dietitian 133V00000X ND546 FL

Addresses

Primary practice location

2380 3Rd St S
Suite 1
Jacksonville Beach, FL 32250-4023

Mailing address

2380 3Rd St S
Suite 1
Jacksonville Beach, FL 32250-4023
Phone (904) 241-3113

National Provider Directory

National Provider Directory
Tax ID family
Beaded Star Recovery LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2380 3rd St S
Ste 1
Jacksonville Beach, FL 32250
Phone (904) 270-1234

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438905600000",
    "number": "1053681205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2380 3RD ST S",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504023",
            "telephone_number": "904-241-3113",
            "fax_number": "904-513-9268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 3RD ST S",
            "address_2": "SUITE 1",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504023",
            "telephone_number": "904-241-3113",
            "fax_number": "904-513-9268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEADED STAR RECOVERY,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2015-08-07",
        "status": "A",
        "authorized_official_last_name": "DAHL",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-241-3113",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RD, LD/N, MBA, CEDRD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "ND546",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH8334",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND546",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.