MEDICARE: SUN HOUSTON, LLC

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	283Q00000X	Psychiatric Hospital
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1477150688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN HOUSTON, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4394
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-0016
Country	:	US
Telephone Number	:	732-747-1800
Fax Number	:	732-747-1818

Provider Business Practice Location Address
First Line	:	7505 FANNIN ST STE 430
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1944
Country	:	US
Telephone Number	:	713-796-2273
Fax Number	:	713-795-5735

Authorized Official
Title or Position	:	SENIR VICE PRESIDENT CORPORATE DEVE
Name	:	TOM ROURKE
Credential	:
Telephone Number	:	972-467-4461

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	01/23/2023

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Directions to “SUN HOUSTON, LLC ” Practice Location

Language	Start Address	Practice Location

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