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General NPI Number Information
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NPI Number | 1578551198
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Entity Type | Organization
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Legal Business Name | LIGHTSHARE BEHAVIORAL WELLNESS AND RECOVERY
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1750 17TH ST STE J2
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City | SARASOTA
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State | FL
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Zip | 34234-8690
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Country | US
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Telephone | 941-366-5333
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Fax |
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Provider Business Mailing Address
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Address Line | 4579 NORTHGATE CT
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City | SARASOTA
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State | FL
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Zip | 34234-2124
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Country | US
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Telephone | 941-552-2078
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Fax | 941-552-2044
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Authorized Official
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Title or Position | CONTRACTING COORDINATOR
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Name | KATIE BRIM
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Credential |
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Telephone | 941-366-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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