Provider Demographics
NPI:1386075695
Name:SUNRISE SPECIALTY CLINIC
Entity type:Organization
Organization Name:SUNRISE SPECIALTY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:H
Authorized Official - Last Name:RHONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-978-4560
Mailing Address - Street 1:709 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5423
Mailing Address - Country:US
Mailing Address - Phone:910-978-4560
Mailing Address - Fax:910-491-1000
Practice Address - Street 1:709 HAY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5423
Practice Address - Country:US
Practice Address - Phone:910-978-4560
Practice Address - Fax:910-491-1000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC660000Medicaid