Provider Demographics
NPI:1285230391
Name:SUNRISE NEURO BEHAVIORAL LLC
Entity Type:Organization
Organization Name:SUNRISE NEURO BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-996-7223
Mailing Address - Street 1:1155 S TELSHOR BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4788
Mailing Address - Country:US
Mailing Address - Phone:915-996-7223
Mailing Address - Fax:
Practice Address - Street 1:1155 S TELSHOR BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4788
Practice Address - Country:US
Practice Address - Phone:915-433-2568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-05
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)