# SUNRISE YOUTH SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609606805
- **Authorized official:** MASON ANDREW PETERSON (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (701) 639-3356

## Contact information

- **Practice address:** 112 UNIVERSITY DR N STE L140, FARGO, ND 58102-4635
- **Practice address phone:** (701) 639-3356
- **Mailing address:** 112 UNIVERSITY DR N STE L140, FARGO, ND 58102-4635
- **Mailing address phone:** (701) 639-3356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/03/2024
- **Last updated:** 08/03/2024