St John'S Recovery Place LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

ST JOHN'S RECOVERY PLACE LLC

Practice address

St Johns Recovery Place LLC
109 Silver Palm Avenue
Melbourne, FL 32901

Phone

(954) 945-2984

NPI assigned

Jul 24, 2020

Organization subpart

No

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

Authorized official

Name

Shannon Michelle Smith

Title

Chief Operations Officer

Phone

(954) 945-2984

Specialties & licenses 1

Addresses

Tax ID family

St John'S Recovery Place 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.

• St John'S Recovery Place LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Deland, FL
  • NPI 1184223406
  NPD tax ID

Locations

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621209600000",
    "number": "1144839283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ST JOHNS RECOVERY PLACE LLC",
            "address_2": "1125 N SUMMIT STREET",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "32112",
            "telephone_number": "954-945-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ST JOHNS RECOVERY PLACE LLC",
            "address_2": "109 SILVER PALM AVENUE",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32901",
            "telephone_number": "954-945-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN'S RECOVERY PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-24",
        "last_updated": "2021-05-17",
        "certification_date": "2021-04-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "954-945-2984"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sri Sai S&S LLC
• Shivakumar Srikantaiah
• Visalakshi Srinivasan, MD
• Govind Vallabh Sriramineni, M.D.
• Kelsi St John
• Edward W St. Mary, MD
• Stacia Poole MD, LLC
• Deborah Lynn Stafford, LMHC, BCBA
• Homer Phillips Stall, MD
• Brianna Stallings, MA, LMHC

• Substance Use Disorder Rehabilitation Clinic/Center in Melbourne, FL
• Providers in Melbourne, 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 May 17, 2021; 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.