Provider Demographics
NPI:1093497935
Name:SUNNY JOURNEY AHEAD LLC
Entity Type:Organization
Organization Name:SUNNY JOURNEY AHEAD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DEJESUS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:917-434-2004
Mailing Address - Street 1:1000 WOODVALE AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-8328
Mailing Address - Country:US
Mailing Address - Phone:704-671-2774
Mailing Address - Fax:
Practice Address - Street 1:1000 WOODVALE AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-8328
Practice Address - Country:US
Practice Address - Phone:704-671-2774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility