Provider Demographics
NPI:1902347610
Name:SOBER BEACON RESIDENCES
Entity Type:Organization
Organization Name:SOBER BEACON RESIDENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:305-814-7623
Mailing Address - Street 1:6944 COLUMBIA CT
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8006
Mailing Address - Country:US
Mailing Address - Phone:305-814-7623
Mailing Address - Fax:954-372-2069
Practice Address - Street 1:1147 BANKS RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-6702
Practice Address - Country:US
Practice Address - Phone:305-814-7623
Practice Address - Fax:954-372-2069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOBER BEGINNINGS TREATMENT CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No347C00000XTransportation ServicesPrivate Vehicle