Provider Demographics
NPI:1073089256
Name:SUN STREET CENTERS
Entity Type:Organization
Organization Name:SUN STREET CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC #LCI0170115
Authorized Official - Phone:831-809-8176
Mailing Address - Street 1:119 CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2013
Mailing Address - Country:US
Mailing Address - Phone:831-272-3983
Mailing Address - Fax:831-272-3986
Practice Address - Street 1:119 CAPITOL ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2013
Practice Address - Country:US
Practice Address - Phone:831-272-3983
Practice Address - Fax:831-272-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATBAOtherBUSINESS LICENSE