Provider Demographics
NPI:1467878702
Name:SUNRISE DETOX TOMS RIVER, LLC
Entity Type:Organization
Organization Name:SUNRISE DETOX TOMS RIVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NSG & LICENSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CARN
Authorized Official - Phone:561-951-8341
Mailing Address - Street 1:2328 10TH AVE N STE 301
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6612
Mailing Address - Country:US
Mailing Address - Phone:561-318-4411
Mailing Address - Fax:
Practice Address - Street 1:16 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4107
Practice Address - Country:US
Practice Address - Phone:732-797-2505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X
NJ1000086324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility