Provider Demographics
NPI:1033502091
Name:SUNSHINE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:SUNSHINE BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHOOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-750-2014
Mailing Address - Street 1:DEPT#880600 PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:949-988-0471
Mailing Address - Fax:949-325-7818
Practice Address - Street 1:34575 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92624-1231
Practice Address - Country:US
Practice Address - Phone:949-988-0471
Practice Address - Fax:949-325-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2024-10-07
Deactivation Date:2019-07-08
Deactivation Code:
Reactivation Date:2019-07-19
Provider Licenses
StateLicense IDTaxonomies
CA300311AP324500000X
CA300311BP324500000X
CA300311CP324500000X
CA300311FP324500000X
CA300311HP324500000X
CA300311DP324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300311APOtherSTATE LICENSE