Organization
SUNSHINE THERAPEUTIC GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA BRUCE LPC (OWNER)
(601) 807-3833
Entity
Organization
Contact information
Practice address
4907 HIGHWAY 84 W, VIDALIA, LA 71373-3579
(601) 807-3833
Mailing address
4907 HIGHWAY 84 W, VIDALIA, LA 71373-3579
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
08/18/2021
Last updated
08/19/2021
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