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General NPI Number Information
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NPI Number | 1851702427
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Entity Type | Organization
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Legal Business Name | SUNRISE HOUSE FOUNDATION, INC.
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Dates
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Enumeration Date | 05/16/2014
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Last Update Date | 05/16/2014
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Provider Practice Location Address
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Address Line | 1122 ROUTE 22 SUITE 204
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092
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Country | US
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Telephone | 973-383-6300
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Fax | 973-383-6929
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Provider Business Mailing Address
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Address Line | PO BOX 600 37 SUNSET INN ROAD
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City | LAFAYETTE
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State | NJ
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Zip | 07848
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Country | US
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Telephone | 973-383-6300
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Fax | 973-383-6929
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Authorized Official
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Title or Position | CFO
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Name | JAMES J KITTEL
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Credential | CPA
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Telephone | 973-383-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 2000354
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License Number State | NJ
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