Provider Demographics
NPI:1467514398
Name:SP BEHAVIORAL LLC
Entity Type:Organization
Organization Name:SP BEHAVIORAL LLC
Other - Org Name:SANDYPINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-738-3300
Mailing Address - Street 1:11301 SE TEQUESTA TER
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-8146
Mailing Address - Country:US
Mailing Address - Phone:561-744-0211
Mailing Address - Fax:561-575-1445
Practice Address - Street 1:11301 SE TEQUESTA TER
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-8146
Practice Address - Country:US
Practice Address - Phone:561-744-0211
Practice Address - Fax:561-575-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4462323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070694917Medicaid