NPIMap

Organization Active NPI

Tides Edge Recovery Services, LLC

  • Substance Abuse Rehabilitation Facility
  • Jacksonville Beach, FL
National Provider Identifier
1891529871
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
TIDES EDGE RECOVERY SERVICES, LLC
Practice address
142 11TH Ave N Ste a
Jacksonville Beach, FL 32250-7224
Phone
(904) 685-9083
NPI assigned
Aug 30, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Authorized official

Name
Patricia Yost
Title
Vice President
Phone
(904) 778-6161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

142 11TH Ave N Ste a
Jacksonville Beach, FL 32250-7224

Mailing address

75 12TH St S
Jacksonville, FL 32250-3422

National Provider Directory

National Provider Directory
Tax ID family
Tides Edge Recovery Services LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

142 11th Ave N
#A
Jacksonville Beach, FL 32250
Phone (904) 685-9083

NPI Registry JSON

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

{
    "created_epoch": "1724976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1891529871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 12TH ST S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322503422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 11TH AVE N STE A",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322507224",
            "telephone_number": "904-685-9083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDES EDGE RECOVERY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-30",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "YOST",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "904-778-6161"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 30, 2024; 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.