Healthcare Provider Details

I. General information

NPI: 1306230123
Provider Name (Legal Business Name): SUNBURST PROJECTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2015
Last Update Date: 06/11/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2143 HURLEY WY. SUITE 240
SACRAMENTO CA
95825
US

IV. Provider business mailing address

2143 HURLEY WY. SUITE 240
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-440-0889
  • Fax: 916-440-1208
Mailing address:
  • Phone: 916-440-0889
  • Fax: 916-440-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number17979
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JACOB MATTHEW BRADLEY-ROWE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 916-440-0889