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NPI Code Detail

MEDICARE: SUNRISE DETOX LAKE WORTH BEACH FL, LLC

MEDICARE: SUNRISE DETOX LAKE WORTH BEACH FL, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility
2324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1023952405
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNRISE DETOX LAKE WORTH BEACH FL, LLC
Provider Business Mailing Address
First Line : PO BOX 1575
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-1018
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3185 BOUTWELL RD
Second Line :
City : LAKE WORTH BEACH
State : FL
Zip : 33461-2610
Country : US
Telephone Number : 561-533-0074
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : ISIDORE BLEIER
Credential :
Telephone Number : 732-948-9995
Provider Enumeration Date : 04/16/2026
Last Update Date : 04/16/2026

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