Provider Demographics
NPI:1205626991
Name:ARISING SUN OF MARYSVILLE, LLC
Entity type:Organization
Organization Name:ARISING SUN OF MARYSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:
Authorized Official - Last Name:STINNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-339-8809
Mailing Address - Street 1:3042 HALEY CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6414 77TH PL NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3355
Practice Address - Country:US
Practice Address - Phone:360-925-6445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging