NPIMap

Organization Active NPI

Tides Edge Recovery Services, LLC

  • Multi-Specialty Clinic/Center
  • Jacksonville Beach, FL
National Provider Identifier
1992228845
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
1601 Issued in FL
Legal business name
TIDES EDGE RECOVERY SERVICES, LLC
Practice address
1597 The Greens Way
Jacksonville Beach, FL 32250-1401
Phone
(904) 685-9083
NPI assigned
Jul 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Patricia Yost
Title
Ceo
Phone
(904) 236-5999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 1601 FL Primary

Addresses

Primary practice location

1597 The Greens Way
Jacksonville Beach, FL 32250-1401

Mailing address

390 16TH Ave S
Jacksonville Beach, FL 32250-4961
Phone (904) 685-9083

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

1597 The Greens Way
Jacksonville Beach, FL 32250
Phone (904) 425-9648

NPI Registry JSON

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

{
    "created_epoch": "1500854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1992228845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 16TH AVE S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504961",
            "telephone_number": "904-685-9083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1597 THE GREENS WAY",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322501401",
            "telephone_number": "904-685-9083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDES EDGE RECOVERY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-24",
        "last_updated": "2022-07-21",
        "certification_date": "2019-12-19",
        "status": "A",
        "authorized_official_last_name": "YOST",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-236-5999"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "FL",
            "license": "1601",
            "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 Jul 21, 2022; 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.