Provider Demographics
NPI:1104026004
Name:SUN STREET CENTERS
Entity Type:Organization
Organization Name:SUN STREET CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC
Authorized Official - Phone:831-809-8176
Mailing Address - Street 1:11 PEACH DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3714
Mailing Address - Country:US
Mailing Address - Phone:831-753-6001
Mailing Address - Fax:831-753-5169
Practice Address - Street 1:12 SUN STREET
Practice Address - Street 2:SUN STREET CENTERS OP
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3714
Practice Address - Country:US
Practice Address - Phone:831-753-6001
Practice Address - Fax:831-753-5169
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN STREET CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270003N261QR0405X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA270003NOtherCALIFORNIA DEPARTMENT OF
CA270003BNOtherSTATE LICENSE