Provider Demographics
NPI:1891435467
Name:SUNRISE TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:SUNRISE TREATMENT CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-941-9999
Mailing Address - Street 1:6460 HARRISON AVE. SUITE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247
Mailing Address - Country:US
Mailing Address - Phone:513-467-2825
Mailing Address - Fax:
Practice Address - Street 1:7075 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3053
Practice Address - Country:US
Practice Address - Phone:513-941-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE TREATMENT CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-31
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0473452Medicaid
KY7100776770Medicaid
OH0473839Medicaid