Provider Demographics
NPI:1023522984
Name:SUNRISE DEPENDENCY SOLUTIONS LLC
Entity type:Organization
Organization Name:SUNRISE DEPENDENCY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-587-3438
Mailing Address - Street 1:3160 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6322
Mailing Address - Country:US
Mailing Address - Phone:412-587-3438
Mailing Address - Fax:
Practice Address - Street 1:4212 CYPRESS PARK DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8417
Practice Address - Country:US
Practice Address - Phone:540-400-7841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101254261261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder