MEDICARE: SUNRISE MENTAL HEALTH 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1568161800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	2517 E LAUREL ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-2377
Country	:	US
Telephone Number	:	480-330-3138
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 E RIVER RD STE 105
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6586
Country	:	US
Telephone Number	:	520-524-6565
Fax Number	:	520-495-3477

Authorized Official
Title or Position	:	CEO
Name	:	BRAD STODDARD
Credential	:
Telephone Number	:	480-330-3138

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	01/23/2026

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