Organization
FOOTPRINTS BEACHSIDE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN ROBERT TEMPLETON (CEO)
(727) 954-3908
Entity
Organization
Contact information
Practice address
151 107TH AVE, #13, TREASURE ISLAND, FL 33706-4734
(727) 954-3908
Mailing address
151 107TH AVE, #13, TREASURE ISLAND, FL 33706-4734
(727) 954-3908
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
0652AD547004
FL
Other
Enumeration date
06/23/2011
Last updated
10/20/2014
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