Provider Demographics
NPI:1073910931
Name:SUN-RISE LIVING BEHAVIOR HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:SUN-RISE LIVING BEHAVIOR HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-745-0067
Mailing Address - Street 1:943 CESERY BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5655
Mailing Address - Country:US
Mailing Address - Phone:904-745-0067
Mailing Address - Fax:
Practice Address - Street 1:943 CESERY BLVD STE G
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5655
Practice Address - Country:US
Practice Address - Phone:904-745-0067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty