Provider Demographics
NPI:1619369071
Name:SUNCOAST RC, LLC
Entity Type:Organization
Organization Name:SUNCOAST RC, LLC
Other - Org Name:ADVANTAGE MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HERVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-600-8093
Mailing Address - Street 1:28465 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2511
Mailing Address - Country:US
Mailing Address - Phone:727-600-8093
Mailing Address - Fax:727-240-0604
Practice Address - Street 1:28465 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2511
Practice Address - Country:US
Practice Address - Phone:727-600-8093
Practice Address - Fax:727-240-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108154101YM0800X
FLARNP2194342101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty