Provider Demographics
NPI:1164904108
Name:SUN STREET CENTERS
Entity Type:Organization
Organization Name:SUN STREET CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC
Authorized Official - Phone:831-809-8176
Mailing Address - Street 1:11 PEACH DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3710
Mailing Address - Country:US
Mailing Address - Phone:831-753-5145
Mailing Address - Fax:831-753-6005
Practice Address - Street 1:637 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3231
Practice Address - Country:US
Practice Address - Phone:831-525-8101
Practice Address - Fax:831-525-8130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN STREET CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
324500000X
CA00324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA270003HNOtherCA DHCS