Provider Demographics
NPI:1811291115
Name:SUNRISE CLINICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:SUNRISE CLINICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:ONUOHA
Authorized Official - Last Name:ODIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-451-6337
Mailing Address - Street 1:3500 WESTGATE DR
Mailing Address - Street 2:SUITE 604
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2567
Mailing Address - Country:US
Mailing Address - Phone:919-493-5013
Mailing Address - Fax:919-493-5026
Practice Address - Street 1:3500 WESTGATE DR
Practice Address - Street 2:SUITE 604
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2567
Practice Address - Country:US
Practice Address - Phone:919-493-5013
Practice Address - Fax:919-493-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410109Medicaid