Provider Demographics
NPI:1891010690
Name:SUN STREET CENTERS OUTPATIENT RECOVERY SERVICES
Entity type:Organization
Organization Name:SUN STREET CENTERS OUTPATIENT RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CAS/NCAC I
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:831-753-6001
Mailing Address - Fax:
Practice Address - Street 1:280 CALLE CEBU
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-753-6001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN STREET CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-05
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270003BN261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACARF 1OtherCARF
CA270003BNOtherCALIFORNIA DEPT. OF ALCOHOL AND DRUG PROGRAMS
CACAARR 1OtherCALIFORNIA ASSOCIATION ALCOHOL AND OTHER ADDICTION RESOURCES