Provider Demographics
NPI:1053988923
Name:SUNRISE BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:SUNRISE BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:OKEY
Authorized Official - Last Name:ANYANWU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:908-418-7920
Mailing Address - Street 1:11 DUNDAR RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3553
Mailing Address - Country:US
Mailing Address - Phone:908-418-7920
Mailing Address - Fax:
Practice Address - Street 1:11 DUNDAR RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3553
Practice Address - Country:US
Practice Address - Phone:908-418-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0601225Medicaid