MEDICARE: SUNSHINE RECOVERY CENTER, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	5001	FL

General Provider Information

NPI Number	:	1578009239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE RECOVERY CENTER, LLC.

Provider Business Mailing Address
First Line	:	2508 N AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5639
Country	:	US
Telephone Number	:	561-257-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 N AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-5639
Country	:	US
Telephone Number	:	561-257-4422
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN BELOLO
Credential	:
Telephone Number	:	561-789-9359

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	07/21/2022

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