Healthcare Provider Details

I. General information

NPI: 1508365982
Provider Name (Legal Business Name): SUN COAST RECOVERY RANCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HANCOCK RD
SOUTHWEST RANCHES FL
33330
US

IV. Provider business mailing address

4801 HANCOCK RD
SOUTHWEST RANCHES FL
33330-2209
US

V. Phone/Fax

Practice location:
  • Phone: 954-900-3114
  • Fax:
Mailing address:
  • Phone: 954-900-3114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SALVATORE PACE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 786-999-4322