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General NPI Number Information
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NPI Number | 1073910931
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Entity Type | Organization
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Legal Business Name | SUN-RISE LIVING BEHAVIOR HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 1257 EDGEWOOD AVE W
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City | JACKSONVILLE
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State | FL
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Zip | 32208-2741
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Country | US
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Telephone | 904-745-0067
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Fax | 904-586-2550
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Provider Business Mailing Address
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Address Line | 1257 EDGEWOOD AVE W
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City | JACKSONVILLE
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State | FL
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Zip | 32208-2741
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Country | US
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Telephone | 904-745-0067
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Fax | 904-586-2550
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Authorized Official
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Title or Position | CEO
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Name | MIGUEL MORENO-COLON
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Credential |
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Telephone | 904-745-0067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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