Healthcare Provider Details

I. General information

NPI: 1518329390
Provider Name (Legal Business Name): SUNNYHILL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 ARMBRUSTER RD
DE SOTO MO
63020-4506
US

IV. Provider business mailing address

11140 S TOWNE SQ
SAINT LOUIS MO
63123-7830
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-2188
  • Fax: 636-586-2189
Mailing address:
  • Phone: 314-845-3900
  • Fax: 314-845-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number043935
License Number StateMO

VIII. Authorized Official

Name: VICTORIA JAMES
Title or Position: PRESIDENT / CEO
Credential:
Phone: 314-845-3900