Provider Demographics
NPI:1093176919
Name:SONRISE YOUTH SERVICES
Entity Type:Organization
Organization Name:SONRISE YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-814-0764
Mailing Address - Street 1:9 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2651
Mailing Address - Country:US
Mailing Address - Phone:732-814-0764
Mailing Address - Fax:
Practice Address - Street 1:9 OXFORD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-2651
Practice Address - Country:US
Practice Address - Phone:732-814-0764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-19
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health