Provider Demographics
NPI:1508365982
Name:SUN COAST RECOVERY RANCH LLC
Entity Type:Organization
Organization Name:SUN COAST RECOVERY RANCH LLC
Other - Org Name:SUN COAST RECOVERY RANCH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORGIANNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-200-2053
Mailing Address - Street 1:4801 HANCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2209
Mailing Address - Country:US
Mailing Address - Phone:954-900-3114
Mailing Address - Fax:
Practice Address - Street 1:4801 HANCOCK RD
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33330
Practice Address - Country:US
Practice Address - Phone:954-900-3114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherPRIVATE