Healthcare Provider Details

I. General information

NPI: 1659212579
Provider Name (Legal Business Name): SUNRISE DETOX TOMS RIVER NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WHITESVILLE RD STE A
TOMS RIVER NJ
08753-4105
US

IV. Provider business mailing address

PO BOX 1575
LAKEWOOD NJ
08701-1018
US

V. Phone/Fax

Practice location:
  • Phone: 732-797-2505
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

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