Basic Information
| Provider Information | |||||||||
| NPI: | 1477150688 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUN HOUSTON, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SUN BEHAVIORAL HOUSTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 BROAD ST STE 403 | ||||||||
| Address2: | |||||||||
| City: | RED BANK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077011938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327471800 | ||||||||
| FaxNumber: | 7327471818 | ||||||||
| Practice Location | |||||||||
| Address1: | 7505 FANNIN ST STE 430 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137962273 | ||||||||
| FaxNumber: | 7137955735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2020 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROURKE | ||||||||
| AuthorizedOfficialFirstName: | TOM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIR VICE PRESIDENT CORPORATE DEVE | ||||||||
| AuthorizedOfficialTelephone: | 9724674461 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | N | Hospitals | Psychiatric Hospital | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.