Provider Demographics
NPI:1295444073
Name:SUNSHINE ADVANTAGE OF NM
Entity type:Organization
Organization Name:SUNSHINE ADVANTAGE OF NM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTSCHEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-523-2327
Mailing Address - Street 1:1439 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5440
Mailing Address - Country:US
Mailing Address - Phone:732-523-2327
Mailing Address - Fax:
Practice Address - Street 1:150 WASHINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2038
Practice Address - Country:US
Practice Address - Phone:732-523-2327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty