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General NPI Number Information
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NPI Number | 1336404417
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Entity Type | Organization
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Legal Business Name | SUNRISE CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 22 BALL ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-3521
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Country | US
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Telephone | 739-372-1095
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Fax | 973-372-1096
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Provider Business Mailing Address
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Address Line | 22 BALL ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-3521
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Country | US
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Telephone | 973-372-1095
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Fax | 973-372-1096
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Authorized Official
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Title or Position | ADMIN
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Name | TERRYANN MAREE DECHERT
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Credential | CPB
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Telephone | 201-600-1812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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