The Shores Treatment & Recovery Services, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

1956AD703301 Issued in FL

Legal business name

THE SHORES TREATMENT & RECOVERY SERVICES, LLC

Practice address

1405 SE Goldtree Dr
Suite a
Port Saint Lucie, FL 34952-7563

Phone

(772) 800-3990

NPI assigned

Aug 27, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Lyle Ryant Fried, CAP ICADC

Title

President & Ceo

Phone

(772) 800-3990

Specialties & licenses 4

Addresses

Other names 1

• The Shores Other name

Tax ID family

Shores Treatment and Recovery Service LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Shores Treatment and Recovery Service LLC

  • Children's Substance Abuse Rehabilitation Facility
  • Port St Lucie, FL
  • NPI 1326485475
  NPD tax ID
• The Shores Treatment and Recovery

  • Addiction (Substance Use Disorder) Psychologist
  • Port Saint Lucie, FL
  • NPI 1619356888
  NPD tax ID
• The Shores Treatment and Recovery Service, LLC

  • Multi-Specialty Clinic/Center
  • Port St Lucie, FL
  • NPI 1083074835
  NPD tax ID

Locations

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

{
    "created_epoch": "1377561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1588098495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 SE GOLDTREE DR",
            "address_2": "SUITE A",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527563",
            "telephone_number": "772-800-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 SE GOLDTREE DR",
            "address_2": "SUITE A",
            "city": "PORT SAINT LUCIE",
            "state": "FL",
            "postal_code": "349527563",
            "telephone_number": "772-800-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE SHORES TREATMENT & RECOVERY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-27",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "FRIED",
        "authorized_official_first_name": "LYLE",
        "authorized_official_middle_name": "RYANT",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "772-800-3990",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CAP ICADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "1956AD703301",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11953",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "4809",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "FL",
            "license": "1956AD703301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Shores",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Substance Abuse Rehabilitation Facility in Port Saint Lucie, FL
• Providers in Port Saint Lucie, FL by specialty
• Substance Abuse Rehabilitation Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; 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.