Provider Demographics
NPI:1558610493
Name:SUNNY RIDGE FAMILY CENTER, INC
Entity Type:Organization
Organization Name:SUNNY RIDGE FAMILY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR FOR PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-754-7500
Mailing Address - Street 1:270 REMINGTON BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3592
Mailing Address - Country:US
Mailing Address - Phone:630-754-4514
Mailing Address - Fax:630-754-4501
Practice Address - Street 1:270 REMINGTON BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3592
Practice Address - Country:US
Practice Address - Phone:630-754-4514
Practice Address - Fax:630-754-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health