Organization
BAYSHORE RETREAT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY JENKS (COO)
(850) 269-3975
Entity
Organization
Contact information
Practice address
457 CAHOUN AVE, DESTIN, FL 32541
(850) 269-3975
Mailing address
PO BOX 365, DESTIN, FL 32540-0365
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
0146AD1561-01
FL
Other
Enumeration date
07/08/2011
Last updated
07/08/2011
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