Healthcare Provider Details

I. General information

NPI: 1659371763
Provider Name (Legal Business Name): SUNCOAST CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 CENTRAL AVE
ST PETERSBURG FL
33711-1239
US

IV. Provider business mailing address

PO BOX 10970
ST PETERSBURG FL
33733-0970
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-7656
  • Fax: 727-322-2130
Mailing address:
  • Phone: 727-327-7656
  • Fax: 727-327-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA E. DAIRE
Title or Position: PRESIDENT/CEO
Credential: LCSW
Phone: 727-327-7656