1073175279 NPI number — SUNSHINE BEHAVIORAL HEALTH LLC

Table of content: (NPI 1073175279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073175279 NPI number — SUNSHINE BEHAVIORAL HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSHINE BEHAVIORAL HEALTH LLC
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:
6
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:
1073175279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT#880600 PO BOX 29650
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85038-9650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-988-0471
Provider Business Mailing Address Fax Number:
949-325-7818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
283 UPLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92651-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-877-6873
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2019

Additional Information

Authorized Official

Authorized Official Last Name:
VANHOOSER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF COMPLIANCE
Authorized Official Telephone Number:
949-750-2014

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300311FP . This is a "CALIFORNIA DHCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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