Provider Demographics
NPI:1083365704
Name:SUNNYBROOK PRTF
Entity Type:Organization
Organization Name:SUNNYBROOK PRTF
Other - Org Name:SUNNYBROOK PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RASHAE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-853-5689
Mailing Address - Street 1:6540 RYEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1802
Mailing Address - Country:US
Mailing Address - Phone:910-853-5689
Mailing Address - Fax:
Practice Address - Street 1:6540 RYEFIELD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1802
Practice Address - Country:US
Practice Address - Phone:910-853-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility