MEDICARE: SUNRISE TREATMENT CENTER, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598120214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE TREATMENT CENTER, LLC

Provider Business Mailing Address
First Line	:	6460 HARRISON AVE STE 200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7958
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:	513-941-7555

Provider Business Practice Location Address
First Line	:	680 NORTHLAND BLVD
Second Line	:
City	:	FOREST PARK
State	:	OH
Zip	:	45240-3248
Country	:	US
Telephone Number	:	513-941-4999
Fax Number	:	513-941-7555

Authorized Official
Title or Position	:	COO
Name	:	STEVEN SMITH
Credential	:	LPC, LICDC-CS
Telephone Number	:	513-467-3772

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	06/03/2024

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