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General NPI Number Information
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NPI Number | 1851182844
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Entity Type | Organization
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Legal Business Name | SISU LIVING HOUSE
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 1420 SPRINGSHIRE CT
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City | RALEIGH
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State | NC
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Zip | 27610-2561
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Country | US
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Telephone | 984-381-6313
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Fax |
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Provider Business Mailing Address
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Address Line | 8041 BRIER CREEK PKWY # 1083
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City | RALEIGH
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State | NC
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Zip | 27617-7596
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Country | US
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Telephone | 919-637-6865
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JUANYETTA BEASLEY
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Credential | DHA, RN
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Telephone | 919-637-6865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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