=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134381338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNRISE HOUSE PROGRAM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2008
-----------------------------------------------------
Last Update Date | 06/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2309 PLATT DR
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94553-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-229-2318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2309 PLATT DR
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94553-5018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-229-2318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | SUSAN CINELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-229-2318
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------