Provider Demographics
NPI:1740763275
Name:SUN RIVER HEALTH INC
Entity type:Organization
Organization Name:SUN RIVER HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF INFORMATION AND PRACTICE MGMT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-384-2375
Mailing Address - Street 1:PO BOX 5036
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-5036
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:1543-1545 INWOOD AVENUE
Practice Address - Street 2:HUDSON RIVER HEALTHCARE ADULT DAY PROGRAM
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2505
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN RIVER HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-11
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicaid