Healthcare Provider Details

I. General information

NPI: 1679852677
Provider Name (Legal Business Name): SUNRISE HILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12592 SIMMONS RD
HAMPTON GA
30228-6102
US

IV. Provider business mailing address

265 REDDING RDG
COLLEGE PARK GA
30349-8027
US

V. Phone/Fax

Practice location:
  • Phone: 404-767-7737
  • Fax: 404-521-4527
Mailing address:
  • Phone: 404-767-7737
  • Fax: 404-521-4527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberPCH006870
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberPCH006870
License Number StateGA

VIII. Authorized Official

Name: DR. MELINDA D RICHARDS
Title or Position: CEO
Credential:
Phone: 404-767-7737