Provider Demographics
NPI:1841664539
Name:SUN COAST RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:SUN COAST RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORGIANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-200-2053
Mailing Address - Street 1:10235 W SAMPLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3982
Mailing Address - Country:US
Mailing Address - Phone:954-786-2627
Mailing Address - Fax:
Practice Address - Street 1:10235 W SAMPLE RD STE 200
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3982
Practice Address - Country:US
Practice Address - Phone:954-786-2627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health