Healthcare Provider Details

I. General information

NPI: 1992256945
Provider Name (Legal Business Name): SUNNYHILL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 S TOWNE SQ SUITE 100
SAINT LOUIS MO
63123-7830
US

IV. Provider business mailing address

11140 S TOWNE SQ SUITE 100
SAINT LOUIS MO
63123-7830
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2011008097
License Number StateMO

VIII. Authorized Official

Name: MR. DONALD WILLIS MITCHELL III
Title or Position: VICE PRESIDENT OF CLIENT SERVICES
Credential: BCBA, LBA
Phone: 314-845-3900