Provider Demographics
NPI:1942364997
Name:SUNNY DENYAAVEE CENTER
Entity Type:Organization
Organization Name:SUNNY DENYAAVEE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNNYBOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-455-4611
Mailing Address - Street 1:59 COLLEGE RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-1702
Mailing Address - Country:US
Mailing Address - Phone:907-455-4611
Mailing Address - Fax:907-374-8303
Practice Address - Street 1:59 COLLEGE RD
Practice Address - Street 2:SUITE 213
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-1702
Practice Address - Country:US
Practice Address - Phone:907-455-4611
Practice Address - Fax:907-374-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK712170101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty