Provider Demographics
NPI:1164197869
Name:SUNRISE NATIVE RECOVERY, LLC
Entity Type:Organization
Organization Name:SUNRISE NATIVE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:QUINDT
Authorized Official - Suffix:V
Authorized Official - Credentials:
Authorized Official - Phone:760-215-1844
Mailing Address - Street 1:14747 N NORTHSIGHT BLVD STE 111-270
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15170 N HAYDEN RD STE 5
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2571
Practice Address - Country:US
Practice Address - Phone:866-488-1854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility