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NPI Code Detail

MEDICARE: SUNRISE DETOX III, LLC

MEDICARE: SUNRISE DETOX III, 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
1324500000XSubstance Abuse Rehabilitation Facility1706AD576201FL
2320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1700135399
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNRISE DETOX III, LLC
Provider Business Mailing Address
First Line : 2328 10TH AVE N
Second Line : #301
City : LAKE WORTH
State : FL
Zip : 33461-6606
Country : US
Telephone Number : 561-318-4414
Fax Number : 561-533-3832
Provider Business Practice Location Address
First Line : 2331 NE 53RD ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33308-3235
Country : US
Telephone Number : 954-491-9700
Fax Number : 561-228-0836
Authorized Official
Title or Position : DIRECTOR
Name : MS. JASON USILTON
Credential :
Telephone Number : 561-318-4400
Provider Enumeration Date : 08/29/2012
Last Update Date : 10/11/2023

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Directions to “SUNRISE DETOX III, LLC ” Practice Location

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