Provider Demographics
NPI:1710340807
Name:SUNRISE TREATMENT CENTER - LABORATORY
Entity Type:Organization
Organization Name:SUNRISE TREATMENT CENTER - LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LICDC-CS
Authorized Official - Phone:513-941-4999
Mailing Address - Street 1:6460 HARRISON AVE. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-2019
Mailing Address - Country:US
Mailing Address - Phone:513-467-2825
Mailing Address - Fax:
Practice Address - Street 1:680 NORTHLAND BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3248
Practice Address - Country:US
Practice Address - Phone:513-941-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE TREATMENT CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-05
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0078786Medicaid