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NPI Code Detail

MEDICARE: SUNRISE DETOX FORT LAUDERDALE FL, LLC

MEDICARE: SUNRISE DETOX FORT LAUDERDALE FL, 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
1324500000XSubstance Abuse Rehabilitation Facility
2320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1629912001
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNRISE DETOX FORT LAUDERDALE FL, LLC
Provider Business Mailing Address
First Line : PO BOX 1575
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1018
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2331 NE 53RD ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-3235
Country : US
Telephone Number : 954-491-9700
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : JOEL HERSKO
Credential :
Telephone Number : 347-661-0013
Provider Enumeration Date : 04/16/2026
Last Update Date : 04/16/2026

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Directions to “SUNRISE DETOX FORT LAUDERDALE FL, LLC ” Practice Location

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