Healthcare Provider Details

I. General information

NPI: 1740106301
Provider Name (Legal Business Name): SUNSTATE COMMUNITY LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 GREENWOOD AVE
WEST PALM BEACH FL
33407-4726
US

IV. Provider business mailing address

2004 CARTER LANDING BLVD
JACKSONVILLE FL
32221-5631
US

V. Phone/Fax

Practice location:
  • Phone: 786-506-1282
  • Fax:
Mailing address:
  • Phone: 786-506-1282
  • 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 TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. FERNAND BONTEMPS
Title or Position: MANAGER
Credential:
Phone: 786-506-1282