Provider Demographics
NPI:1912577024
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBEY
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:941-366-5333
Mailing Address - Fax:
Practice Address - Street 1:1451 10TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4048
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:2021-06-30
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110260500Medicaid