Provider Demographics
NPI:1861850778
Name:SUN STREET CENTERS
Entity Type:Organization
Organization Name:SUN STREET CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC
Authorized Official - Phone:831-809-8176
Mailing Address - Street 1:11 PEACH DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3710
Mailing Address - Country:US
Mailing Address - Phone:831-753-5135
Mailing Address - Fax:
Practice Address - Street 1:1201 ECHO AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-3719
Practice Address - Country:US
Practice Address - Phone:831-393-9316
Practice Address - Fax:831-899-6565
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN STREET CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-05
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA270003ENOtherSTATE OF CALIFORNIA SUBSTANCE USE DISORDER LICENSE FOR OUTPATIENT
CA3YR/2016OtherC.A.R.F. COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES