MEDICARE: LIGHTSHARE BEHAVIORAL WELLNESS AND RECOVERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	284300000X	Special Hospital
4	324500000X	Substance Abuse Rehabilitation Facility
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578551198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTSHARE BEHAVIORAL WELLNESS AND RECOVERY

Provider Business Mailing Address
First Line	:	4579 NORTHGATE CT
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-2124
Country	:	US
Telephone Number	:	941-552-2078
Fax Number	:	941-552-2044

Provider Business Practice Location Address
First Line	:	1750 17TH ST STE J2
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34234-8690
Country	:	US
Telephone Number	:	941-366-5333
Fax Number	:

Authorized Official
Title or Position	:	CONTRACTING COORDINATOR
Name	:	KATIE BRIM
Credential	:
Telephone Number	:	941-366-5333

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	06/03/2025

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Directions to “LIGHTSHARE BEHAVIORAL WELLNESS AND RECOVERY ” Practice Location

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