Healthcare Provider Details

I. General information

NPI: 1376160945
Provider Name (Legal Business Name): SUNRISE OUTREACH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 DOLLARWAY RD STE 401
WHITE HALL AR
71602-3083
US

IV. Provider business mailing address

PO BOX 622
SHERIDAN AR
72150-0622
US

V. Phone/Fax

Practice location:
  • Phone: 870-466-4754
  • Fax:
Mailing address:
  • Phone: 870-466-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN L CHENNAULT
Title or Position: CEO
Credential:
Phone: 870-466-4754