| Sunrise Treatment Center - West Side | |
|
6460 Harrison Ave Ste 200 Cincinnati OH 45247-7958 | |
| (513) 941-4999 | |
| (513) 941-7555 |
| Full Name | Sunrise Treatment Center - West Side |
|---|---|
| Speciality | Clinic/Center |
| Location | 6460 Harrison Ave Ste 200, Cincinnati, Ohio |
| Authorized Official Name and Position | Randy Spaulding (COO/CLINICAL DIRECTOR) |
| Authorized Official Contact | 5134672825 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sunrise Treatment Center - West Side 6460 Harrison Ave. Suite 200 Cincinnati OH 45247-7957 Ph: (513) 467-2825 | Sunrise Treatment Center - West Side 6460 Harrison Ave Ste 200 Cincinnati OH 45247-7958 Ph: (513) 941-4999 |
| NPI Number | 1992043053 |
|---|---|
| Provider Enumeration Date | 01/24/2013 |
| Last Update Date | 03/31/2022 |
| Certification Date | 03/31/2022 |
| Medicare PECOS PAC ID | 8628336617 |
|---|---|
| Medicare Enrollment ID | O20180313001475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992043053 | NPI | - | NPPES |
| 0078786 | Medicaid | OH | |
| 0313320 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
| Provider Name | Michael Marcotte |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1326046889 PECOS PAC ID: 5890751457 Enrollment ID: I20050203000265 |
| Provider Name | Arshad Javed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306895842 PECOS PAC ID: 6204811722 Enrollment ID: I20061011000027 |
| Provider Name | Christopher W Aviles |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265521066 PECOS PAC ID: 1052310505 Enrollment ID: I20061211000058 |
| Provider Name | David Dean Brill |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851311559 PECOS PAC ID: 9234130592 Enrollment ID: I20070130000044 |
| Provider Name | Patti A Ellison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144260035 PECOS PAC ID: 7618145921 Enrollment ID: I20110712000334 |
| Provider Name | Stacey M Poe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285024588 PECOS PAC ID: 4880993062 Enrollment ID: I20160422001531 |
| Provider Name | Marla Bradley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568904779 PECOS PAC ID: 5294016440 Enrollment ID: I20161229001307 |
| Provider Name | Heidi Lynn Hamburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548651466 PECOS PAC ID: 5890077341 Enrollment ID: I20170118002878 |
| Provider Name | Sarah M Roberson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518404409 PECOS PAC ID: 9638453384 Enrollment ID: I20170224002394 |
| Provider Name | Julie M Schulkers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235659194 PECOS PAC ID: 8224302120 Enrollment ID: I20170915001237 |
| Provider Name | Nabil Samir Gems Ghobril |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184901803 PECOS PAC ID: 9931324910 Enrollment ID: I20180622002748 |
| Provider Name | Sherry L Mauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467933077 PECOS PAC ID: 7810237880 Enrollment ID: I20190823002164 |
| Provider Name | Katherine Lawrence |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801321559 PECOS PAC ID: 9739511379 Enrollment ID: I20191119002929 |
| Provider Name | Amie Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679053821 PECOS PAC ID: 2466492681 Enrollment ID: I20191206000348 |
| Provider Name | Jenna C Sierer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033683693 PECOS PAC ID: 3870990161 Enrollment ID: I20211026002212 |
| Provider Name | Shiny George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063003077 PECOS PAC ID: 3072991132 Enrollment ID: I20220601001006 |
| Provider Name | Angela Michelle Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881817617 PECOS PAC ID: 2365800406 Enrollment ID: I20230621002385 |
| Provider Name | Amanda Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154844041 PECOS PAC ID: 2264706878 Enrollment ID: I20230712000375 |
| Provider Name | Rene' E. Hamilton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407394794 PECOS PAC ID: 8921469305 Enrollment ID: I20230801003827 |
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