Provider Demographics
NPI:1194436881
Name:SHORELINE TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:SHORELINE TREATMENT CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARNACKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-442-7689
Mailing Address - Street 1:207 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1748
Mailing Address - Country:US
Mailing Address - Phone:615-864-8145
Mailing Address - Fax:
Practice Address - Street 1:207 PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1748
Practice Address - Country:US
Practice Address - Phone:615-864-8145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility