1740763275 NPI number — SUN RIVER HEALTH INC

Table of content: (NPI 1740763275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740763275 NPI number — SUN RIVER HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUN RIVER HEALTH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUN RIVER HEALTH INC ADULT DAY PROGRAM
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740763275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10602-5036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-734-8800
Provider Business Mailing Address Fax Number:
914-734-8786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1543-1545 INWOOD AVENUE
Provider Second Line Business Practice Location Address:
HUDSON RIVER HEALTHCARE ADULT DAY PROGRAM
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10452-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-681-8700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIPTON
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
VP OF INFORMATION AND PRACTICE MGMT
Authorized Official Telephone Number:
914-384-2375

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00473038 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".