Provider Demographics
NPI:1558768820
Name:DETOX OF SOUTH FLORIDA, LLC
Entity Type:Organization
Organization Name:DETOX OF SOUTH FLORIDA, LLC
Other - Org Name:SUNSHINE DIAGNOSTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SEHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-368-1285
Mailing Address - Street 1:608 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2622
Mailing Address - Country:US
Mailing Address - Phone:754-368-1285
Mailing Address - Fax:833-535-0164
Practice Address - Street 1:608 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2622
Practice Address - Country:US
Practice Address - Phone:863-763-0913
Practice Address - Fax:863-763-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility