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General NPI Number Information
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NPI Number | 1831484666
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Entity Type | Organization
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Legal Business Name | SUNCOAST BEHAVIORAL LLC
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 12012 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5631
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Country | US
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Telephone | 813-677-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 12012 BOYETTE RD
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City | RIVERVIEW
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State | FL
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Zip | 33569-5631
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Country | US
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Telephone | 813-677-6700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEFF TURICZEK
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Credential |
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Telephone | 813-677-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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