Healthcare Provider Details

I. General information

NPI: 1891464467
Provider Name (Legal Business Name): SUNSHINE BEHAVIORAL HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19067 W FRONTAGE RD
RAYMOND IL
62560-5053
US

IV. Provider business mailing address

DEPT#880620 PO BOX 29650
PHOENIX AZ
85038-9650
US

V. Phone/Fax

Practice location:
  • Phone: 949-988-0471
  • Fax:
Mailing address:
  • Phone: 949-750-2014
  • Fax: 949-325-7818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN VANHOOSER
Title or Position: DIRECTOR OF COMPLIANCE
Credential: CADC-II
Phone: 949-750-2014