Provider Demographics
NPI:1023556099
Name:SUNRISE CENTRE, INC
Entity Type:Organization
Organization Name:SUNRISE CENTRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-340-1100
Mailing Address - Street 1:630 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1832
Mailing Address - Country:US
Mailing Address - Phone:989-356-6649
Mailing Address - Fax:989-356-3559
Practice Address - Street 1:630 WALNUT ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1832
Practice Address - Country:US
Practice Address - Phone:989-356-6649
Practice Address - Fax:989-356-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health