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NPI Code Detail

MEDICARE: SUNCOAST BEHAVIORAL LLC

MEDICARE: SUNCOAST BEHAVIORAL 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2323P00000XPsychiatric Residential Treatment Facility

General Provider Information

NPI Number : 1831484666
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNCOAST BEHAVIORAL LLC
Provider Business Mailing Address
First Line : 12012 BOYETTE RD
Second Line :
City : RIVERVIEW
State : FL
Zip : 33569-5631
Country : US
Telephone Number : 813-677-6700
Fax Number :
Provider Business Practice Location Address
First Line : 12012 BOYETTE RD
Second Line :
City : RIVERVIEW
State : FL
Zip : 33569-5631
Country : US
Telephone Number : 813-677-6700
Fax Number :
Authorized Official
Title or Position : CEO
Name : JEFF TURICZEK
Credential :
Telephone Number : 813-677-6700
Provider Enumeration Date : 06/09/2011
Last Update Date : 06/15/2011

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Directions to “SUNCOAST BEHAVIORAL LLC ” Practice Location

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