MEDICARE: SUNCOAST DETOX 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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1447795018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNCOAST DETOX LLC

Provider Business Mailing Address
First Line	:	9935 PALOMINO DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-1014
Country	:	US
Telephone Number	:	561-301-9423
Fax Number	:

Provider Business Practice Location Address
First Line	:	9935 PALOMINO DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-1014
Country	:	US
Telephone Number	:	561-301-9423
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EVA DUDEK
Credential	:
Telephone Number	:	561-301-9423

Provider Enumeration Date	:	01/05/2017
Last Update Date	:	01/05/2017

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Directions to “SUNCOAST DETOX LLC ” Practice Location

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