Healthcare Provider Details

I. General information

NPI: 1114627726
Provider Name (Legal Business Name): SHORELINE TREATMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 E PACIFIC COAST HWY STE 120
LONG BEACH CA
90804-6939
US

IV. Provider business mailing address

4510 E PACIFIC COAST HWY STE 120
LONG BEACH CA
90804-6939
US

V. Phone/Fax

Practice location:
  • Phone: 615-864-8145
  • Fax:
Mailing address:
  • Phone: 615-864-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SARNACKE
Title or Position: CFO
Credential:
Phone: 615-442-7689