MEDICARE: SUNRISE BEHAVIORAL HEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366834228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE BEHAVIORAL HEALTH INC.

Provider Business Mailing Address
First Line	:	4654 HAYGOOD RD
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5448
Country	:	US
Telephone Number	:	757-431-7321
Fax Number	:

Provider Business Practice Location Address
First Line	:	4654 HAYGOOD RD
Second Line	:	SUITE B
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5448
Country	:	US
Telephone Number	:	757-431-7321
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHARLES DEON HALE
Credential	:
Telephone Number	:	757-431-7321

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	10/03/2015

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