=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346560729
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NARCONON SUNCOAST, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2010
-----------------------------------------------------
Last Update Date | 12/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1390 SUNSET POINT ROAD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-304-4176
-----------------------------------------------------
Fax | 954-208-5770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1390 SUNSET POINT ROAD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-304-4176
-----------------------------------------------------
Fax | 954-208-5770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURY SECRETARY
-----------------------------------------------------
Name | MR. SEAN STRICKLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-587-7771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number | 0527AD198301
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------