Provider Demographics
NPI:1578551198
Name:LIGHTSHARE BEHAVIORAL WELLNESS AND RECOVERY
Entity Type:Organization
Organization Name:LIGHTSHARE BEHAVIORAL WELLNESS AND RECOVERY
Other - Org Name:FIRST STEP OF SARASOTA, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CONTRACTING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-366-5333
Mailing Address - Street 1:4579 NORTHGATE CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-2124
Mailing Address - Country:US
Mailing Address - Phone:941-552-2078
Mailing Address - Fax:941-552-2044
Practice Address - Street 1:1750 17TH ST STE J2
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8690
Practice Address - Country:US
Practice Address - Phone:941-366-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003605400Medicaid