Basic Information
| Provider Information | |||||||||
| NPI: | 1023410255 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNNY HILLS BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 W BASTANCHURY RD | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928352522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147734111 | ||||||||
| FaxNumber: | 7147734222 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W BASTANCHURY RD | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928352522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147734111 | ||||||||
| FaxNumber: | 7147734222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2014 | ||||||||
| LastUpdateDate: | 09/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | MODY | ||||||||
| AuthorizedOfficialFirstName: | NAWAZ | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7147734111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF65512 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.