Provider Demographics
NPI:1942566674
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:Other 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:941-552-2078
Mailing Address - Fax:941-953-4673
Practice Address - Street 1:1726 18TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8604
Practice Address - Country:US
Practice Address - Phone:941-552-2067
Practice Address - Fax:941-552-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6510251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003605406Medicaid