Provider Demographics
NPI:1023553369
Name:SUNRISE COLLABORATIVE, LLC.
Entity Type:Organization
Organization Name:SUNRISE COLLABORATIVE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PHILHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:724-422-3928
Mailing Address - Street 1:1048 PENNSYLVANIA AVE W
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-1838
Mailing Address - Country:US
Mailing Address - Phone:814-230-9111
Mailing Address - Fax:814-313-1075
Practice Address - Street 1:1048 PENNSYLVANIA AVE W
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-1838
Practice Address - Country:US
Practice Address - Phone:724-422-3928
Practice Address - Fax:814-313-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-22
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X, 2084P0800X, 363LP0808X
PACW0171351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231047Medicare PIN