Provider Demographics
NPI:1629602263
Name:SUNSHINE COMMUNITY & BEHAVIOR SERVICES CORP
Entity Type:Organization
Organization Name:SUNSHINE COMMUNITY & BEHAVIOR SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-431-1376
Mailing Address - Street 1:33550 S DIXIE HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-5651
Mailing Address - Country:US
Mailing Address - Phone:305-431-1376
Mailing Address - Fax:
Practice Address - Street 1:33550 S DIXIE HWY STE 106
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-5651
Practice Address - Country:US
Practice Address - Phone:305-431-1376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-22
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management