Healthcare Provider Details

I. General information

NPI: 1467878702
Provider Name (Legal Business Name): SUNRISE DETOX TOMS RIVER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WHITESVILLE RD
TOMS RIVER NJ
08753-4107
US

IV. Provider business mailing address

2328 10TH AVE N STE 301
LAKE WORTH FL
33461-6612
US

V. Phone/Fax

Practice location:
  • Phone: 732-797-2505
  • Fax:
Mailing address:
  • Phone: 561-318-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1000086
License Number StateNJ

VIII. Authorized Official

Name: LINDA R BURNS
Title or Position: CHIEF NSG & LICENSING OFFICER
Credential: RN, CARN
Phone: 561-951-8341