Provider Demographics
NPI:1346991973
Name:SUN STREET CENTERS
Entity Type:Organization
Organization Name:SUN STREET CENTERS
Other - Org Name:SUN STREET CENTERS
Other - Org Type:Other Name
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 1:34 PRADO ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:831-809-8176
Mailing Address - Fax:831-753-5163
Practice Address - Street 1:34 PRADO ROAD
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:831-753-5135
Practice Address - Fax:831-753-5163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN STREET CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-14
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility