Bayshore Retreat, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

0146AD1561-01 Issued in FL

Legal business name

BAYSHORE RETREAT, LLC

Practice address

457 Cahoun Ave
Destin, FL 32541

Phone

(850) 269-3975

NPI assigned

Jul 8, 2011

Organization subpart

No

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

Authorized official

Name

Jeffrey Jenks

Title

Coo

Phone

(850) 269-3975

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310083200000",
    "number": "1982991121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325400365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 CAHOUN AVE",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "32541",
            "telephone_number": "850-269-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSHORE RETREAT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2011-07-08",
        "status": "A",
        "authorized_official_last_name": "JENKS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "850-269-3975"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "FL",
            "license": "0146AD1561-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Destin, FL
• Providers in Destin, 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 Jul 8, 2011; 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.