Healthcare Provider Details

I. General information

NPI: 1255801973
Provider Name (Legal Business Name): SUNSPIRE HEALTH HILTON HEAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ARLEY WAY STE 101
BLUFFTON SC
29910-4883
US

IV. Provider business mailing address

19820 N 7TH ST STE 205
PHOENIX AZ
85024-1694
US

V. Phone/Fax

Practice location:
  • Phone: 843-473-3350
  • Fax: 843-473-3333
Mailing address:
  • Phone: 928-684-4039
  • Fax: 623-581-7624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TUVIA FRIEDMAN
Title or Position: PARTNER
Credential:
Phone: 347-622-3605