# TIDES EDGE RECOVERY SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992228845
- **Authorized official:** PATRICIA YOST (CEO)
- **Authorized official phone:** (904) 236-5999

## Contact information

- **Practice address:** 1597 THE GREENS WAY, JACKSONVILLE BEACH, FL 32250-1401
- **Practice address phone:** (904) 685-9083
- **Mailing address:** 390 16TH AVE S, JACKSONVILLE BEACH, FL 32250-4961
- **Mailing address phone:** (904) 685-9083

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | 1601 | FL | Yes |

## Other

- **Enumeration date:** 07/24/2017
- **Last updated:** 07/21/2022