Basic Information
| Provider Information | |||||||||
| NPI: | 1467878702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNRISE DETOX TOMS RIVER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2328 10TH AVE N STE 301 | ||||||||
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| City: | LAKE WORTH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334616612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613184411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16 WHITESVILLE RD | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087534107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327972505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2014 | ||||||||
| LastUpdateDate: | 03/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | BURNS | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF NSG & LICENSING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5619518341 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, CARN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 1000086 | NJ | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.