1194393660 NPI number — SUNSHINE BEHAVIORAL HEALTH SERVICES, CORP.

Table of content: (NPI 1194393660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194393660 NPI number — SUNSHINE BEHAVIORAL HEALTH SERVICES, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSHINE BEHAVIORAL HEALTH SERVICES, CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194393660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 972377
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33197-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-998-4248
Provider Business Mailing Address Fax Number:
786-265-0977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103400 OVERSEAS HWY STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEY LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33037-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-998-4248
Provider Business Practice Location Address Fax Number:
786-265-0977
Provider Enumeration Date:
06/11/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
LUIS MANUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF EXECUTIVE SERVICES
Authorized Official Telephone Number:
305-998-4248

Provider Taxonomy Codes

  • Taxonomy code: 106E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110926500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".