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

1045 Williamsburg Rd
Deland, FL 32720-1449

Phone

(954) 945-2984

Fax

(904) 990-1201

NPI assigned

Oct 19, 2020

Organization subpart

No

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

Authorized official

Name

Shannon Smith

Title

Coo

Phone

(954) 945-2984

Specialties & licenses 1

Addresses

Other names 1

• St John's Recovery Place llc Doing business as

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
  • Melbourne, FL
  • NPI 1144839283
  NPD tax ID

Locations

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

{
    "created_epoch": "1603065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603065600000",
    "number": "1184223406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 N SUMMIT ST",
            "city": "CRESCENT CITY",
            "state": "FL",
            "postal_code": "321121721",
            "telephone_number": "954-945-2984",
            "fax_number": "904-990-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 WILLIAMSBURG RD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327201449",
            "telephone_number": "954-945-2984",
            "fax_number": "904-990-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN'S RECOVERY PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-19",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "COO",
        "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": [
        {
            "organization_name": "St John's Recovery Place llc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Speech Compass, LLC
• Lori Leshan Speed
• Logan Speicher
• Spine Motion DX II LLC
• Srinivasa Sridhar, MD
• Stanley F. Stockhammer, Jr. D.O., P.a.
• Starlight Assisted Lining at Deland
• Starting Point Mental Health, LLC
• Brandon M Steen, M.D.
• Malcolm Steen, DDS

• Substance Use Disorder Rehabilitation Clinic/Center in Deland, FL
• Providers in Deland, 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 Oct 19, 2020; 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.