Healthcare Provider Details

I. General information

NPI: 1538009170
Provider Name (Legal Business Name): SUNRISE DETOX MILLBURY MA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 MAIN ST STE 200
MILLBURY MA
01527-2005
US

IV. Provider business mailing address

PO BOX 1575
LAKEWOOD NJ
08701-1018
US

V. Phone/Fax

Practice location:
  • Phone: 508-581-5225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATHIAS DEUTSCH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-684-4749