Healthcare Provider Details

I. General information

NPI: 1073089256
Provider Name (Legal Business Name): SUN STREET CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 CAPITOL ST
SALINAS CA
93901-2013
US

IV. Provider business mailing address

119 CAPITOL ST
SALINAS CA
93901-2013
US

V. Phone/Fax

Practice location:
  • Phone: 831-272-3983
  • Fax: 831-272-3986
Mailing address:
  • Phone: 831-272-3983
  • Fax: 831-272-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: GORDON WILLIAM HORNE
Title or Position: CLINICAL SUPERVISOR
Credential: LAADC #LCI0170115
Phone: 831-809-8176