ST JOHN'S RECOVERY PLACE LLC NPI 1215429436

NPI Information

  • NPI: 1215429436
  • Provider Name: ST JOHN'S RECOVERY PLACE LLC
  • Classification: Substance Abuse Rehabilitation Facility - 324500000X
  • Entity Type: Organization
  • CLIA Number: 10D2158379
  • Address: 1125 N SUMMIT ST
    CRESCENT CITY, FL
    ZIP 32112
  • Phone: (954) 945-2984

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NPI Details

ST JOHN'S RECOVERY PLACE LLC is a substance abuse rehabilitation facility in Crescent City, FL. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. ST JOHN'S RECOVERY PLACE LLC NPI is 1215429436. The provider is registered as an organization entity type.

The provider's business location address is:

1125 N SUMMIT ST
CRESCENT CITY, FL
ZIP 32112-721
Phone: (954) 945-2984

The provider's authorized official is Shimon Buhadana .
The authorized official title is Ceo/owner and has the following contact phone number (954) 658-7148.

The CLIA number assigned to this NPI record is 10D2158379 - other - subs abuse center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2018 and was last updated on 6/4/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1324500000XSubstance Abuse Rehabilitation FacilityYes

What is NPI?

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This page was last updated on: 11/21/2025

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