Provider Demographics
NPI:1366834228
Name:SUNRISE BEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:SUNRISE BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DEON
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-431-7321
Mailing Address - Street 1:4654 HAYGOOD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5448
Mailing Address - Country:US
Mailing Address - Phone:757-431-7321
Mailing Address - Fax:
Practice Address - Street 1:4654 HAYGOOD RD
Practice Address - Street 2:SUITE B
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5448
Practice Address - Country:US
Practice Address - Phone:757-431-7321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health