Healthcare Provider Details

I. General information

NPI: 1851182844
Provider Name (Legal Business Name): SISU LIVING HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SPRINGSHIRE CT
RALEIGH NC
27610-2561
US

IV. Provider business mailing address

8041 BRIER CREEK PKWY # 1083
RALEIGH NC
27617-7596
US

V. Phone/Fax

Practice location:
  • Phone: 984-381-6313
  • Fax:
Mailing address:
  • Phone: 919-637-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JUANYETTA BEASLEY
Title or Position: EXECUTIVE DIRECTOR
Credential: DHA, RN
Phone: 919-637-6865