Provider Demographics
NPI:1154484103
Name:SUNRISE DETOXIFICATION CENTER, LLC
Entity Type:Organization
Organization Name:SUNRISE DETOXIFICATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:STOKES
Authorized Official - Middle Name:
Authorized Official - Last Name:AITKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-318-4411
Mailing Address - Street 1:2328 10TH AVE #301
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-318-4414
Mailing Address - Fax:561-423-0363
Practice Address - Street 1:3185 BOUTWELL RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-533-0074
Practice Address - Fax:561-533-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
FL0950AD113400324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness