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Organization

FOOTPRINTS BEACHSIDE RECOVERY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NICOLA RAJARAM (BILLING MANAGER)
(954) 272-6723
Entity
Organization

Contact information

Practice address
151 107TH AVE, SUITE 13, TREASURE ISLAND, FL 33706-4734
(727) 954-3908
Mailing address
151 107TH AVE, SUITE 13, TREASURE ISLAND, FL 33706-4734

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
FL

Other

Enumeration date
05/31/2016
Last updated
05/31/2016
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