Provider Demographics
NPI:1508227562
Name:SUN RAY HOLDING COMPANY, LLC
Entity Type:Organization
Organization Name:SUN RAY HOLDING COMPANY, LLC
Other - Org Name:SUN RAY ADDICTIONS COUNSELING & EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-266-7682
Mailing Address - Street 1:PO BOX 101774
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-1774
Mailing Address - Country:US
Mailing Address - Phone:772-247-1428
Mailing Address - Fax:772-210-5697
Practice Address - Street 1:31641 AUTO CENTER DR
Practice Address - Street 2:ROOM 1
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4535
Practice Address - Country:US
Practice Address - Phone:772-247-1782
Practice Address - Fax:772-210-2758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN RAY COAST TREATMENT CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-17
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty