Organization
ST JOHN'S RECOVERY PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON MICHELLE SMITH (CHIEF OPERATIONS OFFICER)
(954) 945-2984
Entity
Organization
Contact information
Practice address
ST JOHNS RECOVERY PLACE LLC, 109 SILVER PALM AVENUE, MELBOURNE, FL 32901
(954) 945-2984
Mailing address
ST JOHNS RECOVERY PLACE LLC, 1125 N SUMMIT STREET, CRESCENT CITY, FL 32112
(954) 945-2984
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
07/24/2020
Last updated
05/17/2021
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