Healthcare Provider Details

I. General information

NPI: 1013859271
Provider Name (Legal Business Name): SUNRISE DETOX DULUTH GA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 N BERKELEY LAKE RD NW STE A
DULUTH GA
30096-3006
US

IV. Provider business mailing address

PO BOX 1575
LAKEWOOD NJ
08701-1018
US

V. Phone/Fax

Practice location:
  • Phone: 561-318-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOEL HERSKO
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 347-661-0013