Provider Demographics
NPI:1063870962
Name:SUN STREET CENTERS
Entity type:Organization
Organization Name:SUN STREET CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
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 1:3043 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-4763
Practice Address - Country:US
Practice Address - Phone:831-582-9461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN STREET CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-05
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270003BN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3 YRS/2016OtherCARF COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES
CA270003BNOtherSTATE OF CALIFORNIA SUBSTANCE USE DISORDER OUTPATIENT TREATMENT LICENSE