Healthcare Provider Details

I. General information

NPI: 1699108381
Provider Name (Legal Business Name): SUNNY HILL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 GRAY ST
FESTUS MO
63028-1949
US

IV. Provider business mailing address

11140 S TOWNE SQ SUITE101
SAINT LOUIS MO
63123-7830
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-4701
  • Fax:
Mailing address:
  • Phone: 314-845-3900
  • Fax: 314-845-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberEL20812INIT
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number041353
License Number StateMO

VIII. Authorized Official

Name: MRS. VICTORIA JAMES
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 636-274-9044