| Organization Name: | BEADED STAR RECOVERY,LLC |
| NPI Number: | 1053681205 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARILYN K DAHL (OWNER) |
| Mailing Address: | 2380 3rd St S Suite 1 Jacksonville Beach |
| State: | FL US |
| Postal Code: | 322504023 |
| Phone Number: | 9042413113 |
| Fax Number: | 9045139268 |
| NPI Enumeration Date: | 01/05/2012 |
| NPI Last Update Date: | 08/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | ND546 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |