Healthcare Provider Details

I. General information

NPI: 1942978697
Provider Name (Legal Business Name): SUN BEHAVIOR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 40TH ST UNIT 3
MESA AZ
85205-3812
US

IV. Provider business mailing address

1550 N 40TH ST UNIT 3
MESA AZ
85205-3812
US

V. Phone/Fax

Practice location:
  • Phone: 919-771-3680
  • Fax:
Mailing address:
  • Phone: 919-771-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAIF ALI
Title or Position: OWNER
Credential:
Phone: 919-771-3680